Basic Psychological Concepts

UNDERSTANDING TRAUMA IN CAMBODIA

!"#$%&'(!)*+,*-
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Greetings rom the Director
o Deutscher Lntwicklungsdienst ,DLD,
in Cambodia

It is my pleasure to endorse this !rst olume o
the landbook on 1rauma` as an outcome o
our cooperation with the Center or Social Deel-
opment ,CSD,. \ithin its special program Ciil
Peace Serice` ,ZlD,, Deutscher Lntwicklungs-
dienst ,DLD, German Deelopment Serice, is
supporting CSD`s public orums on justice and
reconciliation.
1hese eents are organized throughout Cambodia.
1hey aim to promote outreach or the Khmer
Rouge 1ribunal and to inole the whole popula-
tion in the process.
1hereore, I warmly congratulate and thank CSD`s
Lxecutie Director, 1heary C. Seng, and all em-
ployees o the organization including DLD`s ex-
pert on trauma therapy, Mr. Matthias \itzel, or
publishing this aluable book. \ith human com-
passion and by learning together we hae the
chance to oercome the remnants o the past.

\olgang Mollers
Director
Deutscher Lntwicklungsdienst ,DLD,
Acknowledgements
\e are indebted to all the Cambodians who hae supported us with their time, ex-
pertise and knowledge. \e are especially grateul to those who shared their personal
experiences about their suering during the Khmer Rouge years, and gae the land-
book`s authors inaluable insights into the complex processes o Cambodian trauma.
Our debt to them is substantial. \e express our sincere thanks to trauma-therapist
Roswitha \I1ZLL, editors o the Lnglish text lolly 1LLLRAN1, and Lrin PULASKI. Our special
gratitude goes to those who hae assisted in editing the Khmer text, especially to Ms. 1heary C. SLNG,
Dr. ClLK Sotha, and Mr. SLOUNG Sothearwat. 1ranslating and editing these psychological concepts
into Khmer was not only labor-intensie, but also a long-term process, requiring outstanding and serious
engagement. linally, we are indebted to the German Deelopment Serice ,DLD, and the German Ciil
Peace Serice ,ZlD,, the donors o this publication.
\IM Sotheary ,1ranslation, Design,, OM Chariya ,1ranslation,, SAM Sarath ,Illustrations,
Matthias \I1ZLL ,1ext, Graphics, Design, Photos,
!"#$%&'(#)%" +$%, -./('#)0/ 1)$/(#%$2 341
Phnom Penh, 8 October 200
I am deeply proud o this Understanding 1rauma in Cambodia landbook! I beliee this landbook is a must-read or eery Cambodian - not
only or specialists, NGO workers or the expatriate community - who has been touched by immense loss, and trust that in the process o reading
comes understanding, and with understanding comes healing.
Some 18 months ago, I was thrilled when the Center or Social Deelopment ,CSD`, was approached by Mr. \olgang Mollers o the German
Deelopment Serice ,DLD`, to do collaboratie work with DLD on issues o justice and reconciliation in light o the Khmer Rouge 1ribunal,
I was doubly elated to hear that DLD would additionally support us with a consultant, and not just any consultant, but one with expertise in
trauma and psychology.
Immediately, CSD exploited the expertise and generosity o our new consultant, psycho-therapist Matthias \itzel by engaging himin many actiities
and projects. lor me, at the ery top o the list o priorities o great urgency was the creation o a handbook on introduction to psychology and
trauma, as I had yet to know or read o such a book with basic psychological concepts that was written or and about Cambodians.
lrom our knowledge o our society ,in terms o literacy, attentieness, particularly to unexplored topics such as trauma and psychology, and
based on our experience o haing created other handbooks in the past, we knew that this handbook has to be accessible and practical or eery
Cambodian - light in text, ree o conolution, attractie and presentable with illustrations, photos and colorul, creatie layouts.
I beliee we hae succeeded brilliantly with this landbook. I can be unabashedly proud o this work because my only contribution is the idea
or its inception and language editing. All the credit o the landbook !rst and oremost goes to Mr. Matthias \itzel, the author, layout designer,
riend, counselor extraordinaire, then there are the superb CSD sta o whom I cannot name all here, but would like to highlight: Ms. \IM
Sotheary and Ms. OM Chariya, the eer thoughtul and caring psychology assistants, Mr. SAM Sarath, the brilliant illustrator, and the all-around
rock star o an employee, my eer tireless executie assistant, Mr. IM Sophea.
O course, we would not be able to produce this landbook without the moral and !nancial support o DLD, particularly the encouragement
and enthusiasm o its Director, Mr. \olgang Mollers.
I was most ortunate to hae grown up or some years in the United States where I could and did seek out materials ,een i on my own, on
trauma and psychology to help me make sense o my tumultuous inner lie and recurring nightmares as a consequence o the Khmer Rouge
years. I am excited and more at peace that now there is this landbook to help guide my ellow Cambodians through the turbulent emotional
terrain o the head and heart and to aid them in making sense o the continuing internal disturbances. Part o the healing process is to understand
and to know that we are not alone. I pray that this landbook will do just that.
1heary C. SLNG
Lxecutie Director
!
1
A study unded by the United States National Institutes o lealth ,NIl, National Institute o Mental lealth ,NIMl,
and National Institute on Alcohol Abuse and Alcoholism ,NIAAA,: Mental lealth Serices Research at the National
Institute o Mental lealth ,2003,: www.nimh.nih.go,publicat,pubListing.cm
"
3
In the past year, sixty-two percent o Cambodians liing in the United States hae suered rom
Post-1raumatic Stress Disorder ,P1SD, and !ty-one percent hae suered rom depression,
seenteen times that o the US national aerage o adults.
1
Regarding the prealence o P1SD
within Cambodia, serious research does not exist until now. Although we hae to discriminate be-
tween local Cambodians and those liing oerseas, perceptions o psychiatrists and psychologists
are that local Cambodians also ace a high prealence o these psychosocial diseases. It is now
obious that many Cambodians today are suering in their hearts rom their preious traumatic
experiences.

In this Understanding 1rauma in Cambodia landbook, we would like to emphasize that symp-
toms o trauma are neither a sign o character weakness nor a reason to be deprecated. Un-
derstanding the origins, reasons, symptoms, impacts, and potential treatments o such trauma
is essential or eerybody in Cambodia. Len many years ater the Khmer Rouge atrocities, the
trauma in the hearts o many Cambodians is still unresoled. 1he legacy o this suering is ap-
parent in personality attributes, attitudes, and behaiors o the young generation in Cambodia.
1he main purpose o this landbook is to proide an introduction to and basic knowledge o
a complex psychological issue in an understandable way. Because the Lxtraordinary Chambers
in the Courts o Cambodia, inormally the Khmer Rouge 1ribunal, is !nally getting underway,
many non-goernmental organizations and many Cambodians are becoming more engaged in
the process o national reconciliation and deelopment, and thereore hae to deal with many
traumatized people. Reconciliation between indiiduals, regions within the nation, and between
ictims and perpetrators in Cambodian illages are among the main issues being tackled by many
NGO outreach projects.
Although these issues are releant or all Cambodians, current knowledge in Cambodia concern-
ing psychological eects o the Khmer Rouge years is largely super!cial. 1hereore, this land-
book seeks to proide a compassionate and proessional approach to dealing with traumatized
people by presenting more detailed psychological and therapeutic knowledge.
\e beliee greater consciousness about the sociopolitical and indiidual aspects o trauma is one
o the !rst steps towards indiidual and national reconciliation. 1he path to reconciliation can-
not exist in this country until there is inner peace in the hearts o indiiduals and more conscious
communication between couples and amongst amilies, illages, and towns.
1he glossary at the end o this landbook de!nes technical terms rom trauma psychology used
in the text o this landbook. Our team worked hard to !nd suitable Khmer de!nitions or
words such as dissociation, de-realization, reezing, and ragmenting because, to date, there is no
comprehensie psychological dictionary in the Khmer language. Although a drat o an Lnglish-
Khmer-lrench Psychology Dictionary exists, written in 1996 by a team o psychologists at the
Royal Uniersity o Phnom Penh, this drat is limited and does not contain any explanations o
the concepts. Some o these words are still not well known in Lnglish and are di!cult to de!ne
in any language.
1: What Is the Purpose of This Handbook?
1
A study unded by the United States National Institutes o lealth ,NIl, National Institute o Mental lealth ,NIMl,
and National Institute on Alcohol Abuse and Alcoholism ,NIAAA,: Mental lealth Serices Research at the National
Institute o Mental lealth ,2003,: www.nimh.nih.go,publicat,pubListing.cm
This Handbook
seeks to present
a more detailed
psychological
and therapeutic
knowledge in
order to provide
a compassionate
and professional
approach in
dealing with
traumatized
people.
Greater
consciousness
about the
sociopolitical
and individual
aspects of
trauma is one of
the rst steps
towards
individual and
national
reconciliation.
#
t
trauma
2
See: http,,de.wikipedia.org Last isited on 10 lebruary 200.
3
See: www.thereedictionary.com Last isited on 15 December 2006.

$
4
Pearlman, L.A. & Saakitne, K.\. ,1995,: 1rauma and the therapist: Countertranserence and icarious
traumatization in psychotherapy with incest suriors. New \ork: \.\. Norton & Company.
5
See: Giller, L., in: www.sidran.org Last isited on 8 Noember 2006.
%
6
Ibid

Allen, J. & Lewis, L. ,1996,: A conceptual ramework or treating traumatic memories and its application to
LMDR. Bulletin o the Menninger Clinic, 60,2,.
8
1rauma, a medical term reerring to an injury or wound, originates rom the Greek language. It
is deried rom the Greek erb titro./o meaning to ierce, but can also mean aavage or aefeat.
2
In the language o daily lie, a trauma` normally reers to a highly stressul eent.
1he noun trauma has two meaning:
1. Physical damage to the body caused by iolence or other physical impact, e.g. an accident,
2. An emotional wound or shock, oten with long-lasting eect.
According to the second meaning, trauma is an emotional wound or shock that creates substantial
and lasting damage to a person`s psychological deelopment, oten leading to neurosis. 1rauma
may result rom an eent or situation that causes great distress and disruption.
3

Psychological trauma is essentially a normal response to an extreme eent. It inoles creating
emotional memories about the distressul eent that are stored in structures deep within the brain.
In general, it is belieed that the more direct the exposure to the traumatic eent, the higher the
risk o emotional harm.
Psychological trauma is the unique indiidual ex-
perience o an eent or conditions in which: ,i,
1he indiidual`s ability to integrate his,her emo-
tional experience is oerwhelmed, and,or ,ii,
1he indiidual ,subjectiely, perceies a threat
to lie, bodily integrity, or sanity.
4

1his de!nition o trauma is airly broad. It in-
cludes responses to powerul isolated incidents
like accidents, natural disasters, crimes, surger-
ies, deaths, and other iolent eents. It also
includes responses to chronic or repetitie ex-
periences such as child abuse, neglect, combat,
urban iolence, concentration camps, iolent
relationships, and enduring depriation.
5
2: Where Does the Word Trauma Come From
and What Does It Mean?
2
See: http,,de.wikipedia.org Last isited on 10 lebruary 200.
3
See: www.thereedictionary.com Last isited on 15 December 2006.
4
Pearlman, L.A. & Saakitne, K.\. ,1995,: 1rauma and the therapist: Countertranserence and icarious
traumatization in psychotherapy with incest suriors. New \ork: \.\. Norton & Company.
5
See: Giller, L., in: www.sidran.org Last isited on 8 Noember 2006.
The Noun Trauma Has Two Meanings
1. Physical bodily damage caused by violence or other physical
impact
2. An emotional wound or shock, often with long-lasting effect.
Trauma is an
emotional
wound or shock
that creates
substantial and
lasting damage
to a persons
psychological
development.
9
!1raumatic experiences shake the oundations o a person`s belies about saety, shatterring their assumptions about trust.
It is an individu-
als subjective
experience
that determines
whether an
event is or is not
traumatic.
6

!Stress generally conuses and distracts a person`s nerous system - but only or a relatiely short period. \ithin a ew
days or weeks, the nerous system tends to calm down and people generally reert to a normal state o equilibrium. low-
eer, returning to normalcy is not the case where the person underwent extreme distress, either in duration ,i.e., prolonged
stress, or impact ,i.e., result o traumatic eent,.
!A trauma can be re-experienced at any time - een ater many years - i let unresoled.
!Regaining mental health means regaining peace o mind and body. 1hereore, it is necessary to be aware o both trau-
ma`s processes and its impact.
!1here are no clear diisions between stress which leads to trauma and stress which leads to adaptation.
1hese aspects o the phenomenon o trauma will be discussed in more detail within the ollowing chapters.
Psychological Trauma
An individuals unique experience of an event or enduring
condition, in which:
1) The individuals ability to integrate his/her emotional
experience is overwhelmed, and/or
2) The individual (subjectively) perceives a threat to life, bod-
ily integrity, or sanity.
6
Ibid

Allen, J. & Lewis, L. ,1996,: A conceptual ramework or treating traumatic memories and its application to
LMDR. Bulletin o the Menninger Clinic, 60,2,.
Some key points to understanding the meaning of psychological trauma:
Essential Aspects of Psychological Trauma
It is the subjective experience of objective events that
constitutes trauma.
The more a person believes s/he is endangered, the more
traumatized s/he will be.
Psychologically, trauma is overwhelming emotion and a
feeling of utter helplessness.
There may or may not be bodily injury, but psychologi-
cal trauma is often coupled with a physiological upheaval
that plays a leading role in the long-range effects.

As traumatic as single shocking events are, the traumatic experiences that result in the most serious mental health
problems are prolonged and repeated, sometimes extending over years of a persons life for example in Cambodia
during the years of the Khmer Rouge Regime.
!!
8
DSM-IV, Diagnostic and Statistical Manual o Mental Disorders, 4th
Ldition, published by the American Psychiatric Association, USA ,2000,.
!"
9
lermann, J.L. ,2003,: Die Narben der Gewalt, Paderborn: Junermann.
13
A traumatic eent is an eent or series o eents that causes moderate to seere stress reactions.

1raumatic eents are those that create a sense o horror, helplessness, serious injury, or threat o
serious injury or death. 1hereore, most o the daily experiences during the Khmer Rouge years can
be de!ned as traumatic eents.
1raumatic eents aect suriors, rescue workers, and riends and relaties o those who hae di-
rectly suered injury or loss. 1hey may also aect people who hae witnessed the eent either !rst-
hand or on teleision. Stressul reactions immediately ollowing a traumatic eent are ery common.
loweer, such reactions usually diminish or are resoled within ten days.
Lidence rom studies o trauma ictims demonstrate that
people react to the same traumatic eent dierently. Some
are proactie, while others merely react. Some are so oer-
whelmed that they are unable to act, and consequently, do
nothing. Proactie people creatiely seek to control a situa-
tion, causing something to happen rather than waiting. 1hese
people tend to oercome and cope well in extremely stressul
situations. People who merely react tend to cope less well.
Moreoer people who are neither proactie nor reactie tend
to deelop serious physical or psychological symptoms or to
die with no noticeable coping actions.

1raumatic eents inole threats to lie or bodily integrity or
a close personal encounter with iolence or death. 1hey con-
ront human beings with helplessness and terror, and eoke
catastrophic responses.
9
3: What Is a Traumatic Event?
Traumatic Event:
An event outside
the range of usual
human experience
which would be
markedly
distressing to
almost anyone.
8
Traumatic events are
extraordinary, not
because they occur rarely,
but rather
because they
overwhelm the ordinary
human adaptations
to life.
8
DSM-IV, Diagnostic and Statistical Manual o Mental Disorders, 4th
Ldition, published by the American Psychiatric Association, USA ,2000,.
9
lermann, J.L. ,2003,: Die Narben der Gewalt, Paderborn: Junermann.
A traumatic event is an event, or series of events,
that cause moderate to severe stressful reactions.
Some people are proactive
(creative seeking to control a
situation, causing something
to happen rather then waiting),
some people only react, and
some people are overwhelmed
to the point of doing nothing.
Trauma results when
an experience is so
overwhelming that
people freeze, go numb,
or disconnect from whats
happening. While this
automatic response
protects people from the
terror they feel, it also
prevents them from
moving on.
!#
!$
!%
18
Research reeals that trauma maniests itsel in two orms: indiidual trauma and psychosocial
trauma.

1he term psychosocial trauma is used to describe the social impact o political, cultural and
economic oppression. \hile some indiiduals witness or endure more than others, perasie
ear, grie and poerty take their toll on the wider community.
Psychosocial trauma reers to both its impact on indiiduals and on society as a whole. In or-
der to be understood, a psychosocial trauma must be considered and analyzed regarding a ery
speci!c socio-cultural context. During the Khmer Rouge regime, nearly the entire population
experienced long-term exposure to a disaster made by their own people,` a man-made or hu-
man-caused disaster which included nationwide atrocities. 1he whole ciil society was destroyed,
people lost their riends and relaties, and because people lied in extreme ear, relationships be-
tween people changed dramatically.
4: What Is Individual and Psychosocial Trauma
in the Cambodian Context?
Trauma has a
double
manifestation:
individual
trauma and
psychosocial
trauma.
The term psychosocial trauma is used to describe the social impact of political, cultural and economic oppression.
While some individuals witness or endure more than others, pervasive fear, grief and anger etc. take their toll on the
wider community. Psychosocial trauma refers to both its impact on individuals and on society as a whole.
When Cambodians began to suffer from these destructive events and for many people this
began long before the Khmer Rouge became the supreme authority - most of them faced three
common elements of psychosocial trauma with impacts on the individual and social context:
(i) Most Cambodians did not expect that there would be a civil war; (ii) Cambodians were
not prepared for these egregious events; and (iii) Cambodians could do nothing to prevent the
traumatic events from happening.

Due to the complete upheaval of Cambodian society, most people were forced into collective
and unique individual experiences of events in which: 1) their daily experiences threatened
life, bodily integrity, or sanity; and 2) the ability to integrate their emotional experiences was
overwhelmed.
Cambodians did not expect that there would be a civil war.

Cambodians were not prepared for these egregious events.

Cambodians could do nothing to prevent the traumatic events from happening.
19
ligure 4.1: Double maniestation o a trauma experience, as indiidual trauma and as psychosocial trauma. \ithin a
speci!c socio-cultural context people are conronted with impact on the indiidual and social leel.
1he impact on the whole Cambodian society still persists:
1his is caused by and corresponds with immature pattern and structures in the leel o personal-
ity deelopment o many Cambodians, who were traumatized during the Khmer Rouge years:
Most Cambodians suriors o the Pol Pot era experienced or witnessed many awul eents, eents
which would normally oerwhelm a person`s capacity to cognitiely and emotionally process their
experiences. Many Cambodians were emotionally shocked oer those years, which understand-
ably led to a breakdown in cognitie processing. Despite such dire trauma, many suriors remain
healthy and continue to be a source o emotional support and encouragement or others.
destruction o peer groups and relationships on many leels
distrust and ear
destructie communication pattern
social disengagement
domestic iolence, etc.
lack o sel esteem lack o anger management lack o creatiity
lack o compassion lack o peaceul communication skills
lack o physical health lack o morality and positie ethic principles, etc.
"!
""
"&
"'
25
Recent technology allowing us to iew brain actiity reeals that trauma can change the structure
and unction o the brain. Studies ound that brain scans o people with relationship or deel-
opmental problems, learning problems, or social problems resulting rom Post-1raumatic Stress
Disorder ,P1SD, hae similar structural and unctional irregularities.

ligure 5.1: 1he structure o the human brain is composed o our main parts: Cerebral Cortex, Limbic system, Cer-
ebellum, and Brain stem.

3/$/5$67 (%$#/. ,also known as "/%(%$#/.,8 1he cerebral cortex, the most recently eoled por-
tion o the brain, is located in the upper part o the brain and includes the rontal cortex. 1his is
where the higher-leel skills o thinking occur, such as logic and reason, understanding the cause
and eect o our actions, and conscious realization o moements.
9),5)( :;:#/,8 1he limbic system sits on top o the brain stem and is buried in the center o
the brain. It represents a more primitie brain structure than the cerebral cortex. 1he limbic
Trauma can
change the
structure and
function of the
brain.
Prefrontal lobe
Future awareness, empathy and moral sense
(Part of the Cerebral cortex)
5: How Does Trauma Effect the Brain?
26
system is the source o our emotions and motiations, especially those linked to surial, i.e. ear,
anger, hunger and sexuality. 1he reason traumatic eents hae such powerul eects on us is
because it acts directly on the brainstem and limbic structures and oerrides our cerebral cortex,
which is responsible or conscious control and rational thought processes.
3/$/5/77',: ,also known as <)"&5$6)",. 1he cerebellum is located at the back base o the
brain. Representing 1,8 o the brain`s mass, it maintains our balance and posture. Moreoer, the
cerebellum coordinates our skilled repetitie moements.
=$6)":#/,: 1he brainstem connects the brain to the spinal cord. It controls many basic unc-
tions, i.e. heart rate, breathing, eating, and sleeping.
ligure 5.4 : Lolutionary process o the deelopment o the brain rom the oldest structure ,brain stem, to the
prerontal lobe within the neocortex: 1raumatic eents hae such powerul eects on us because they act directly
on the early deeloped brain structures such as brain stem and limbic structures. 1hey oerride the more conscious
control and rational thought process o the cerebral cortex with the prerontal lobe, which are deeloped later in our
eolution. 1he goal o this extreme reaction o the brain is to keep the capacity to act.
How Does the Human Brain Process Threatening Information?
!" $%&'() (*+ ,-().,/ 0'12)3-3 rom outside the human organism ,such as a riendly ques-
tion, an interesting piece o inormation, are assimilated and pooled within the #>676,':. 1hen
they moe to the >)??%(6,?':. 1he hippocampus is able to ealuate the impulses and sort tem-
Much of why
traumatic
events have
such powerful
effects on us is
because they
act directly on
the brainstem
and limbic
structures,
and override
the more
conscious
control and
rational
thought
process of the
cortex.
27
porally and specially. 1his structure, like a librarian, helps the brain organize, regulate, and ealu-
ate: I can recognize, I can understand.` lrom the hippocampus the inormation moes to the
(/$/5$67 (%$#/., also known as "/%(%$#/.. \ithin the cerebral cortex, higher leel o thinking
skills occurs, i.e. logic and reason, cause and eect o our actions, and conscious understanding.
1his structure o the brain unctions like a disc and saes all inormation and experiences. 1he
B$%(6@: 6$/6 ,in the inerior rontal gyrus o the +$%"#67 7%5/ - iew graphic, p.21, sorts inorma-
tion linguistically. \hen exposed to traumatic eents, the Broca`s area is inhibited. In turn, people
stagger and become silent.
2. 45-&63.0'2)(.0*7 82*,-().,/9 0'12)3-3 ,like those receied during traumatic eents, are
directed to the 6,;A&676, a tiny but important structure within the 7),5)( :;:#/,, which acts as
the early warning system o the brain. \ithin the amygdala, the brain ealuates the incoming im-
pulses as to whether they are dangerous or the body or the soul. 1his accounts or the organism`s
oer-stimulation during traumatic eents. 1he amygdala is unable to associate and cannot make
rational combinations or undertake logical thinking. loweer, this brain unction was important
to the historical deelopment o the human race, as it was the origin o the !ght and "ight`
reaction ,e.g. a person in an outburst o rage acts on the leel o amygdala and the access to the
cerebral cortex is blocked,. I the amygdala reacts with alarm during a seerely stressul or trau-
matic eent, the inormation will not be sent to the >)??%(6,?': ,at least not at the moment
o shock,. 1he eent remains saed as hot` ,cannot be processed, on the amygdala leel as a
+$6A,/"#/& /.?/$)/"(/ ,See Chapter , lragmenting,. Lmotions, sentiments, images, behaior,
thoughts are recorded in ragments. 1hese unprocessed ragmented experiences, in turn, preent
new inormation rom being saed.
1hereore, chronic stress, such as being exposed to prolonged traumatic eents, causes destructie
structural changes in the brain, which can be seen in computer topography. 1he result is not only
that old inormation` cannot be processed, but also that new inormation is delayed.

I inormation cannot be classi!ed, it will be assessed incorrectly rom the early warning system
,amygdala,. 1his may be prolonged oreer`. lurthermore, the amygdala triggers !)A># %$
"A># ,See Glossary, response, which explains why traumatized people tend to be ery scared,
quick, irritable, and nerous. 1his oten causes suspicious and aggressie behaior as well as a
permanent anxiety and alertness.
10
Two main responses in the brain and their effects on mental health:
Chronic stress,
such as
being exposed
to prolonged
traumatic events,
causes destructive
structural changes
in the brain, which
can be seen in
computer
topography. The
result is not only
that old informa-
tion cannot be
processed, but also
that new informa-
tion is delayed.
1he brain is a network which is able to structure itsel and orient itsel along the inputs o
new inormation. 1he brain is able to process new inormation, to change and to modiy
at any time. 1hus, or traumatized people an adequate therapeutic approach is necessary
and also promising. New inormation, such as adequate therapeutic interention, can
help to process the blocked old` rightening inormation.

lor traumatized people many situations are too loud, hectic, or rightening. I they are
urther exposed to such loud, hectic, and rightening stimuli, which the lippocampus
cannot process, people oten adapt in an unhealthy manner to the enironment. 1hey
themseles become an incorporation` o their incorporated stimuli. 1his means that
they become loud, nerous and rightened.
10
Discussions with Dorsch Witzel, R. (2006), Trauma-Psychotherapist, Zrich/Switzerland.
"(
&)
11
Huber,M. (2003): Trauma und die Folgen, Trauma und Traumabehandlung
Teil 1, Paderborn: Junfermann.
&!
12
Ibid
32
1rauma inoles an unique physical and,or emotional shock that pressures the brain, obliging it
to deal with the situation in a ery speci!c way. 1he inormation system o the brain is "ooded
in such a way that no usual coping mechanisms remain.

Our brain, particularly our brainstem ,See Chapter 5,, is equipped to deal with deadly threats.
\hen "ooded with stress, we automatically and unconsciously react in one o two ways: "ight or
!ght. 1his is guided by our brainstem. 1his situation escalates the !ght or "ight stress response
,eeling angry or scared, into super-stress ,eeling terri!ed, stunned, horri!ed, oerwhelmed,
blanking out,. 1his so-called "ight or !ght` phenomenon means that our brain unconsciously
decides to !ght against the stress actor or, i !ghting is not a good idea, to "ee the situation ,e.g.,
i the perpetrator seems to be much stronger,. In many stressul situations a person is able to
successully preent a trauma by !ghting or "eeing.
In a ery traumatic situation such as torture or rape, where neither "ight nor !ght is possible, the
brain might react with reezing or with ragmenting. lrom the moment we reeze we know un-
consciously that the eent is traumatic and no longer just` a ery stressul situation.
B$//C/ means a kind o paralysis. It is as i the brain says: aov`t bare tbe abitit, to gviae tbe orgavi.v
ovt of tbi. .itvatiov .ecvret,, ava av vot abte to !gbt tbi. etervat aggre..iov. 1hereore, I hae to deend
the aggressie stimulus and gie mysel ,my organism, the permission to dissociate inwardly , See
Chapter : Dissociation ,.
A huge amount o endorphin ,a pain-anaesthetizing opiate produced naturally in the body, allows
the person to mentally disappear` and neutralize` an acute death threat. Also, the noradrenalin
rom the suprarenal gland, which organizes the so called tunnel iew` blocks the naturally inte-
gratie perception, i enough o it rushes through the organism. 1he natural reaction o a person
who aces a traumatic eent would be to scream, cry or help, collapse or weep.
loweer, ery oten, the reezing reaction enables one to alienate onesel rom the terriying
eent. Many people will respond much later with normal reactions. I they regain security and
their brain is charged down` and relaxed again, they suddenly collapse, scream, and cry. But
most people do not immediately respond in this manner. 1heir !rst reaction is to reeze.
6: What Is the Process of Coping with Traumatic Events?
Stress confuses and distracts our nervous system - but only for a relatively short period.
Within a few days or weeks, our nervous system calms down and we revert to a normal
state of equilibrium. However, this return to normality is not the case when we have been
traumatized.
Trauma is stress
run amok.
Freezing
means a kind of
paralysis. The
brain says: I
defend the
aggressive
stimulus and
give myself the
permission to
dissociate
inwardly to
mentally escape
from fear and
pain.
11


11
Huber,M. (2003): Trauma und die Folgen, Trauma und Traumabehandlung Teil 1, Paderborn: Junfermann.
Understanding the "ight or !ght` stress response and the processes o reezing` and rag-
menting`
33
1he brain has another mechanism called +$6A,/"#)"A: 1he threatening experience will be splin-
tered into many pieces, which will be suppressed in such a way that the external eent can no lon-
ger be remembered cohesiely without a ery ocused eort at a later time. 1his reaction is like
a mirror which splinters at the ery moment o the peak o the traumatic stress: 1he remaining
splinters o the mirror don`t reeal a ull picture ,o the traumatic eent,. 1hus, they do not allow
the brain to recognize what kind o eent happened, only that something happened.
\e hae to discriminate: Just as the brain employs to protect a person rom psychological and
physical pain, the psychological ,surial, mechanisms o dissociation ,such as reezing and rag-
menting,, which initially helps people cope with an unbearable moment, may lead to unhealthy
long-term eects. 1his tends to happen when people do not process and integrate their trauma
within some weeks or month ater it occurs ,See Chapter 8,.
ligure 6.2 : 1he unhealthy process o coping with traumatic eents and deeloping a trauma: I "ight` or !ght`
is not possible, reezing` will be a common reaction and the organism adds another mechanism which is called
ragmenting`.
Fragmenting:
The threatening
experience will
splinter into many
pieces, which will
be suppressed in
such a way that
the external event
can no longer be
remembered
cohesively
without a very
focused effort
at a later time.
12
12
Ibid
&#
13
luber,M.,2003,: 1rauma und die lolgen, 1rauma und 1raumabehandlung 1eil 1,
Paderborn: Junermann.
&$
&%
&*
&(
40
1)::%()6#)%", a mental process produces a lack o connection in a person`s thoughts, memories,
eelings, actions, or sense o identity. During the time a person is dissociating, certain inormation
is not associated with other inormation as it normally would be. I a person is dissociating,
s,he seems to think and behae not logically and emotionally incoherent.
\hy does the brain react to stressul situations with dissociation Normally, it is not ery useul
i we are not able to think logically and coherently. loweer, extreme situations call or extreme
measures. I we are in a state o traumatic shock, our nerous system and our brain react intense-
ly, the only goal is to regain the capacity to act. loweer, the cost is an experience o alienation
in which we lose the ability to classiy the actual eent in a temporal, linguistic, and emotionally
coherent manner.
13
1he brain may respond to a ery traumatic situation with dissociation. It is as i the brain says:
I don`t hae the ability to guide the organism out o this situation securely, and I am not able to
!ght this external aggressie stimulus. 1hereore, I hae to deend the aggressie stimulus and
gie the organism the permission to dissociate inwardly`.

7: How Does Dissociation Help to Survive Trauma?
Dissociation, mental process, produces a lack of connection in a persons thoughts, memo-
ries, feelings, actions, or sense of identity. During the time a person is dissociating, certain
information is not associated with other information as it normally would be.
Dissociation
is the process
of becoming
physically and/
or physiological-
ly disconnected
with the internal
and external ef-
fects that occur
during events:
I dont feel any
pain.
This doesnt
happen to me.
This isnt me.
13
luber,M.,2003,: 1rauma und die lolgen, 1rauma und 1raumabehandlung 1eil 1,
Paderborn: Junermann.
For example:
1wo rice !eld workers stepped on a mine. lortunately they didn`t lose any limbs, but both
workers seriously injured both o their legs. One worker lost a lot o blood and collapsed
unconscious. 1he other one acted in a manner o sel-alienation. le behaed ery calmly,
shouldered his colleague and walked or some hundred meters to the next illage, where
they were able to seek a doctor. One could de!ne this as sel-alienation because he had ery
large gashes on both legs, such that his leg bones could be seen. Obiously, this second
worker was in a state o dissociation as he didn`t realize what happened to him. le didn`t
notice the large gashes on his legs. 1he dissociation helped him to stay calm and do his
best to sae the lie o his colleague.
The coping strategy of dissociation allows people to struggle with unfathomable, unbearable
circumstances, but with detachment and suppression of feelings.
41
1he dissociation phenomenon happens through brain processes in the amygdala-system ,part o
the limbic system, responsible or processing eelings, and through a comprehensie breakdown
o the hippocampus, the speech center, and the rontal lobe ,within the cortex,.
1. 1)::%()6#)%" ,6; 5/ 6 ?>/"%,/"%" %+ &6)7; 7)+/, where the capacity to dissociate is ordi-
nary, like driing a car and ater arriing at home not remembering what happened on the streets.
It may also be an attribute o personality. A person who has the ability to dissociate is more
capable o beaming away` rom his or her comprehensie perception o the reality o daily lie.
A person who lacks the ability to dissociate will hae problems blocking out their perceptions i
he or she is oerwhelmed with stimuli. 1his may lead to headaches or other symptoms o stress
such as racing heart, muscle tension, breathing di!culties, etc.
2. lor some people, 1/DE/67)C6#)%" is an automatic reaction in cases o external or internal
stress. 1hey respond with a kind o tunnel ision` ,See Glossary,, whereby they lose awareness
o all elements o the eent that they normally would perceie. People who experience this state
o dissociation report eeling like there is an inisible wall between them and the world, that they
eel like they are always day-dreaming or that their ears and eyes don`t unction as well as beore.
Sometimes, it is as i their mind takes them to another place.

De-Realization is the inner oice that says: All this is not true. 1his has nothing to do with me.
1his is not my lie.` \ith traumatic stress, many people experience eents in this way. Later, the
brain will try to regain the suppressed impressions and to allow the realization to occur: Surely
this is true. 1his really happened to me.`

3. It may be that this realization cannot happen or a long time, because the brain reuses to let
the suppressed impressions - which are still threatening - emerge. 1his may lead to 3>$%")(
1/DE/67)C6#)%" which is important in the context o Post-1raumatic Stress Disorder ,P1SD,.
1hus, what was once a mechanism to protect a person rom oerwhelming impressions becomes
a problem.
Description of Some States of Dissociation:
1. Dissociation as a phenomenon o daily lie
2. De-Realization
3. Chronic De-Realization,
4. Depersonalization and
5. Dissociatie Identity Disorder
,See Glossary,
If we are in a state
of traumatic shock
our nervous
system and our
brain react
intensely.
The only goal
of our
nervous system
is to regain the
capacity to act.
For example:
A women is walking through the rice !elds absorbed in thought. Suddenly she sees two
aggressie men in ront o her. One man tries to hold her arms back and the other starts
to tear her clothes. She realizes that they want to rape her. She sees the hatred in the eyes
o her perpetrators. But in the next moment her perception changes. She thinks to hersel:
I hae seen this once in a !lm. 1his is not reality. 1his is not now`.
Where extremely
stressful traumatic
events cannot be
adequately
processed, the
brain uses
dissociation to
survive and to
disappear from
overwhelming
pain.
The more stress
a person has, the
more likely he is to
dissociate.
42
For example:
A ormer soldier witnessed many atrocities and was also orced to participate in some o
the cruel behaior. le oten eels depressed, but mostly he doesn`t eel anything. le nor-
mally sits inside his house and stares at the walls. le oten doesn`t realize what happens
around him. le perceies the eents in his amily lie as through a glass wall. 1o get out
o this state o intense De-Realization, he sometimes intentionally burns his skin with his
cigarette because a painul eeling is better than no eelings at all.
Dissociation
enables one
to avoid
cognition at the
very moment
of the trauma,
where it is too
dangerous to
face the reality
of the atrocity
in all its
dimensions.
Without the
capacity to
dissociate, many
people couldnt
survive
traumatic
events.
If people are
unable to
integrate the
trauma within
some weeks or
months, they
will suffer from
the destructive
long-term
impact of
dissociation.
1/DE/67)C6#)%"2 %"/ :#6#': %+ 1)::%()6#)%"
F!# ): 6: )+ #>/$/ ): 6 G677 %+ A76:: 5/#G//" ,/ 6"& #>/ G%$7&H
!# ://,: #>6# %+#/" ,; 5%&;2 ,; +//7)"A: 6"& ,; ,)"& 6$/ 6"6/:#>/#)C/&HI
I eel like liing
in a dream
I eel that my
tortured body
is oten disconnected
rom the eelings
o pain
I eel that I can
turn o or detach
rom my emotions
I hae gone through
torture while my
mind was telling me:
`1hat is not me`
4. 1here is also the phenomenon o 1/?/$:%"67)C6#)%". 1his occurs when a person is no longer
able to perceie him-or hersel, or instance, they are no longer able to eel parts o his or her
own body. In this state, the person doesn`t eel pain. Rather, the person eels like s,he is stepping
outside o his or her own body.
For example:
A ictim o torture eels the painul shocks and kicks in"icted on his body by the torture.
\hen it becomes more brutal, he thinks: 1his is only a dream`. Beore he loses conscious-
ness, he eels detached rom his body. le only eels slaps and pressing, nothing else. As
i rom ery ar away, he hears the crying o the torturers and a groaning sound, but he
doesn`t perceie that it comes out o his own mouth.
43
5. 1he most intensie state o dissociation is called the 1)::%()6#)0/ !&/"#)#; 1):%$&/$. 1his
is a ery serious psychiatric disease. In the past, this disease was known as Multiple Personality
Disorder. I a person is multiple traumatized`, his whole personality can break to pieces. In this
dramatic process, the dierent pieces o an indiidual`s personality are deeloping their autono-
mous lie. A person who suers rom this sort o impact o a trauma can behae like many di-
erent persons, without realizing it.
Beside the dierent kinds o dissociation, there are a number o other unhealthy and painul e-
ects rom traumatic experiences. ,See Chapter 10 and 11,.
For example:
A person with this disease does not realize that sometimes s,he behaes as i s,he is ad-
dicted to alcohol and sometimes as i s,he neer drinks alcohol. Neither part o his per-
sonality knows about the existence o the other part. 1he !rst personality ragment may
sometimes beat his wie and his children ater drinking alcohol, and another personality
ragment may be ery engaged against domestic iolence. lis amily and riends realize his
disease, whereas he himsel does not.
ligure .1: Limbic system with .v,gaata, iocavv. and ,otbatavv.. I the brain responds to a ery stressul situ-
ation with dissociation, these brain structures are especially inoled.
'#
'$
'%
'*
49
A trauma can be re-experienced many times throughout one`s lie. It is not true that time heals
all grie and pain. But just as the brain employs to protect the person rom psychological and
physical pain, the psychological mechanism o dissociation`, which initially helps people to cope
with an unbearable moment, may lead to unhealthy long-term eects. 1his tends to happen when
people do not integrate their trauma within some weeks or months ater it occurs.
Many Cambodians who lied through the Khmer Rouge years did not hae the chance to inte-
grate their trauma. 1hey repeatedly had to ace traumatic eents, and then experience the continu-
ous intrusion o new traumatic eents. \ithout any possibility o !nding a sae place to integrate
their eelings o ear and pain, and without any support rom people who were not traumatized
,because eeryone else was traumatized as well,, these Cambodians did not hae an opportunity to
heal during these times. 1he consequence or most was to remain in a state o dissociation. 1hus
they were unable to aoid eeling the ull depth o the pain rom the trauma they experienced:
1he pain would hae been too oerwhelming. 1he coping strategy o dissociation allows people
to struggle with unathomable, unbearable circumstances, but with detachment and suppression
o eelings. A common result o this phenomenon is that rom time to time, the tremendous sup-
pressed grie, sadness, and anger erupts in problematic ways.

\e know rom studying the experiences o suriors o the lolocaust in Germany that there are
always exceptions:
loweer, despite the power o dissociation as a coping mechanism, daily lie proides a number
o opportunities or grie and other eelings to emerge. 1he stimuli which are responsible or
the emerging o these eelings are called triggers. A #$)AA/$ is an eent, an object, a person, or a
sensation that sets a series o thoughts in motion or reminds a person o some aspect o his or
her traumatic past. A person may be unaware o what is triggering the memory ,e.g., loud noises,
a particular color, piece o music, odor, etc.,. But becoming aware o these triggers, and learning
not to oerreact to them, is an important therapeutic task in the treatment o traumatized people
In Cambodian society, daily lie remains !lled with triggers. Lery rightening personal or social
situation may wake the sleeping dogs` o trauma. 1his could be the unstable political situation,
the insensitie statements o Cambodian leaders, or one`s own personal experiences related to
corruption, land grabbing, land mines, rape, domestic iolence, unproessional and unjust courts
and many more societal problems. As long as lie in Cambodia continues to lack real security and
reliability, eery single moment can trigger memories o old traumatic experiences and eelings.
1o handle the challenges o Cambodian lie, people hae had to deelop speci!c psychological
and behaioral coping strategies, which are perasie throughout the country. 1hese coping strat-
egies can be constructie but are mostly destructie, depending on personal and enironmental
conditions ,e.g., aoidance o talking, emotional detachment - see below,

8. Can an Unhealed Trauma Be Re-experienced
After 30 Years?
Some people respond to traumatic experiences with compassion and are able to keep in contact
with their eelings, een when it seems impossible.
1he goal o these coping strategies is to aoid the emergence o too much grie and anger
related to past traumatic eents.
A trauma can be
re-experienced
many times
throughout ones
life. It isnt true
that time heals
all grief and pain.
A trigger is
an event, an
object, a per-
son, etc. that
sets a series
of thoughts in
motion or re-
minds a person
of some aspect
of his or her
traumatic past.
50
Lery rightening personal or social situation may wake the sleeping dogs` o trauma. 1his
could be:
It can be re-experienced een 50 or 60 years later because the perpe-
trators hae still not accepted their guilt. I still hae nightmares some
nights. \hen I see a ew pieces o rice on the table or on the mat while
my children hae their meal, it reminds me o the time that I was so
staring, when I did not hae any rice to eat and did not een know
what rice was. 1his sight pushes me to gie adice to my children and
tell them about the Khmer Rouge era.
\hen I see people with black clothes, it #$)AA/$: ,; ,/,%$; o e-
ery eent that I experienced in the Khmer Rouge era. \hen I go to
isit my home district in Battambang, I remember eery memory I had
there. \hen I walk along the rierside, I remember the un times when
I walked with many riends o mine. I also remember my past when I
see the rice !elds at my hometown. I always tell mysel: Be the owner
o your emotions, don`t let your emotions own you. By this I mean
that we cannot let our emotions control our body and behaior, we
must be the owner o our emotions. I do not let my emotion do what
it wants because I am araid that then people will say I am crazy. \e
cannot deal with those emotions, but we can hae preention.
VANN Nath, 61 years, one of
twelve survivors of Tuol Sleng.
Unortunately, there has yet to be any systematic research into typical Cambodian coping strate-
gies. Neertheless, there are tendencies that are unique to Cambodia, as there are in all countries
attempting to reconcile their speci!c history ater ciil war.
J #>/ '":#657/ ?%7)#)(67 :)#'6#)%"
J #>/ )":/":)#)0/ :#6#/,/"#: %+ 36,5%&)6" 7/6&/$:
J %"/@: %G" ?/$:%"67 /.?/$)/"(/: $/76#/& #% (%$$'?#)%"2 76"& A$655)"A2
76"& ,)"/:2 $6?/2 &%,/:#)( 0)%7/"(/2 '"?$%+/::)%"67 6"& '"K':# (%'$#:
J ,6"; ,%$/ :%()/#67 ?$%57/,:
14
Interiewed by \IM Sotheary and M.\itzel, April 18, 200
51
Some common tendencies, respectively coping mechanisms in Cambodia are:
! L0%)&6"(/ %+ #67M)"A about recent Cambodian history ,whether personal, autobiographi-
cal eents or comprehensie Cambodian history,.
! -,%#)%"67 &/#6(>,/"#, which is characterized by a lack o compassion or the suering
o the weak, the disabled or displaced people. 1he act that Cambodians take extremely
good care o their relaties and riends reeals that compassion is oten ragmented. Being
in touch with one`s own eelings is only possible within the shelter o one`s own amily.
1o aoid triggers, people with background trauma oten choose` to aoid the grie and
despair o strangers. Unortunately, the coping strategies they use to deal with trauma oten
malunction, due to the large amount o triggers in daily lie. Many people channel the trig-
To avoid
triggers,
people with
background
trauma often
choose to
avoid the grief
and despair of
strangers.
A women is triggered by perceiing the situation o domestic iolence
52
gered energy o grie and anger through domestic iolence, alcohol, drug abuse, and other
destructie coping mechanisms.
! B%$,/$ 0)(#),: #$/6#)"A %#>/$ ?/%?7/ 6: #>/; G/$/ #$/6#/& in the time o the atrocities.
Len i they neer act as cruelly as they themseles were treated, some o the behaior
patterns, the perasie threat o iolence, and the tension within proessional relationships
oten eoke the behaior or some aspects o behaior o the ormer perpetrators.
A real alternatie to these mostly unconscious methods o coping with the traumatic past is
to integrate the past trauma through a healing process within a psychological or psychiatric
treatment. 1raditional Cambodian approaches to reconciling the past are also aailable ,See
page 114,.
Lmotional support or ictims o the Khmer Rouge years during outreach actiities.
53
##
#$
#%
58
ligure 10.2 : All o the symptoms depicted here could be aspects o a normal reaction to trauma, and could be part
o the natural healing process, as long as they only last or a brie time.
In order to ocus on the trauma symptoms we can identiy within Cambodian society, we must
consider the special circumstances o the Cambodian situation, where the major traumatic eents
occurred more then 25 years ago. 1hereore, the approach discussed herein is speci!cally orien-
tated towards symptoms that hae lasted a long time. \e can classiy them into three categories o
symptoms: ,i, symptoms related to re-experiencing the trauma, ,ii, symptoms related to emotional
numbing and aoidance, and ,iii, symptoms related to increased or decreased arousal.
9: What Are the Most Common Symptoms
of Emotional Trauma in Cambodia?
Sometimes the
responses to a
traumatic event
are delayed for
months or even
years after the
event.
Often people
do not initially
associate their
symptoms with
the precipitating
trauma.
Reactions to acute trauma can be extremely aried, emerging in each person in a di-
erent combination. Related changes to the body, mind, and emotions may gradually
disappear oer time. loweer, i the symptoms do not disappear or become more
intensie, the person may hae deeloped a serious mental health disease which re-
quires special treatment and support. Sometimes the responses to a traumatic eent
are delayed or months or een years ater the eent. Oten people do not initially
associate their symptoms with the precipitating trauma.
Lack of ability to deal with fear of ghosts
59
E/D/.?/$)/"()"A #>/ N$6',68
Intrusie thoughts ,See Glossary,
llashbacks and nightmares ,See Glossary,
Sudden "oods o emotions or images related to the
traumatic eents
-,%#)%"67 O',5)"A 6"& L0%)&6"(/8
Amnesia
Aoidance o situations that resemble the initial eent
Aoidance o reality through dierent kinds o addiction
Depression
Lmotional Detachment
leelings o guilt
Grie reactions
An altered sense o time
!"($/6:/& L$%':678
lyperigilance ,See Glossary,
An extreme sense o being on guard
Oerreactions, including sudden unprooked anger
General anxiety
Insomnia
Obsessions with death
All o the symptoms described here could be aspects o a normal reaction to trauma, and could
be part o the natural healing process, as long as they only last or a brie time.
\hether a person will respond with prolonged traumatic symptoms or with symptoms, which are
normal emotional reactions during a process o integrating traumatic eents depends on seeral
actors, including the indiidual`s ability to cope with the traumatic eent ,See Chapter 15,.
Trauma
symptoms
are often
functional,
and can be
seen as signs
of a trauma
survivors
system
trying to
reestablish
its balance.
They should
be viewed
as signs of
health, not
illness.
$!
15
1edeschi, R.G., and Calhoun, L.G. ,1996,: 1he post-traumatic growth inentory: Measuring the
positie legacy o trauma. Journal o 1raumatic Stress, Vol. 9, 455-1.
16
Chesler, M. ,2003,: Post-traumatic growth, in: Preention Researcher Vol. 10, 2003, Michigan,
USA.
$"
1
1edeschi, R.G., Park, C. and Calhoun, L.G. ,eds,: ,1998, Post-traumatic
Growth: 1heory and research in the atermath o crisis, Mahwah: Lrlbaum.
18

ibid
$&
19

Seng, 1heary, C. ,2005,: Daughter o the killing !elds. Asrei`s story, London: lusion, p. 259.
20
Seng, 1heary, C. ,2005,: Daughter o the killing !elds. Asrei`s story, London: lusion, p. 262.
$'
$#
66
1here are some common misunderstandings about trauma. 1he most common myth is that trau-
ma symptoms are always a sign o pathology. 1o the contrary, trauma symptoms are oten unc-
tional, and can be seen as signs o a trauma surior`s system trying to re-establish its balance.
1hey should be iewed as signs o health, not illness. 1hey sere important unctions that re"ect
the ictim`s dual need to recognize the reality and impact o their trauma, while denying what is
oerwhelming and unbearable.
1he ariety o positie changes that indiiduals may experience in their struggles with trauma are
described by psychological models o post-traumatic growth
15
. 1hese changes include improed
relationships, new lie options, a greater appreciation or lie, a greater sense o personal strength,
and a deepened sense o spiritual deelopment. 1his re"ects a basic paradox or irony: trauma
suriors oten !nd that their losses hae produced aluable gains.
10: What Kinds of Mental Health Impacts Might
Develop from Traumatic Events?
Post-Traumatic
Growth (PTG) is
the experience
of expression
of positive life
change as an
outcome of a
trauma or
life crisis.

This does
not mean
that anyone
is glad that
they had to
experience
traumatic
events, but
that they
report
having
experienced
benets
or having
made
something
positive out
of it.
16
Figure 10.1 : People have different personal histories, different personality patterns, different coping skills, and
different health conditions before a traumatic event happens. These preconditions inuence the individuals phys-
ical, emotional, and mental responses to a prolonged traumatic event such as a civil war. (See picture, page 57)
15
1edeschi, R.G., and Calhoun, L.G. ,1996,: 1he post-traumatic growth inentory: Measuring the
positie legacy o trauma. Journal o 1raumatic Stress, Vol. 9, 455-1.
16
Chesler, M. ,2003,: Post-traumatic growth, in: Preention Researcher Vol. 10, 2003, Michigan,
USA.
67
Research also shows that other paradoxes arise. lor example, many trauma suriors report that
they eel more ulnerable, yet also stronger. \hile they may hae an increased sense o ulner-
ability, due to their experience o suering rom orces they may not
hae been able to preent or control, these same people may also experi-
ence an increased sense o their own capacities to surie and preail
1
.
Many trauma suriors also report a need to talk about their traumatic
experiences. 1hrough this, they may also !nd an increased comort with
intimacy, and a greater sense o compassion or others who experience
lie`s di!culties.

Indiiduals who hae aced trauma may be more likely to engage with
undamental existential questions about death and the purpose o lie. Others commonly report
a greater appreciation or the smaller things in lie, and a heightened sensitiity to the religious,
spiritual, and existential components o lie
18


Another common misunderstanding is that loss, grie and trauma are the same things. 1hey re-
quently look similar, especially in the acute phase immediately ollowing a traumatic eent. low-
eer, they also inole dierent processes and require treatment appropriate to each. 1rauma is
requently an oerlay on the grie process, and may interere with grieing and mourning i it is
not perceied and addressed separately.
There is a wide spectrum of responses, from
brief emotional reactions to prolonged se-
rious mental health symptoms, which may
arise from exposure to traumatic events.
I do not beliee the tribunal itsel will bring about personal healing. 1hat takes place in the quietness o
one`s soul. lor me, there has been no tribunal but nonetheless I hae emotional health. lealing came with
time, grace, space, distance and an incredible support structure o loing amily members, riends and com-
munity.`
19

\ho is this saage, the Khmer Rouge Is she not I, but only one degree remoed at birth Is her baseness
not within my capability Do we at times not !nd ourseles standing at the edge o a precipice Lie is but a
breath. Lie passionately. Loe deeply. Pray unceasingly.`
20
SLNG 1heary
1
1edeschi, R.G., Park, C. and Calhoun, L.G. ,eds,: ,1998, Post-traumatic
Growth: 1heory and research in the atermath o crisis, Mahwah: Lrlbaum.
18

ibid
19

Seng, 1heary, C. ,2005,: Daughter o the killing !elds. Asrei`s story, London: lusion, p. 259.
20
Seng, 1heary, C. ,2005,: Daughter o the killing !elds. Asrei`s story, London: lusion, p. 262.
68
1rauma symptoms are probably adaptie, and originally eoled to help people recognize and
aoid dangerous experiences. Neertheless, there are a wide spectrum o responses, rom brie
emotional reactions to prolonged serious mental health symptoms, which may arise rom ex-
posure to traumatic eents. lor example, indiidual responses may range rom brie reactie
conditions, such as mild anxiety, to Post-1raumatic Stress Disorder ,P1SD,, or major psychiatric
illnesses, such as schizophrenia or personality disorders. Some are more serious than others, and
people who suer rom more seere disorders like P1SD de!nitely require proessional help, and
should seek psychological or psychiatric treatment.
ligure 10.2 : Possible healthy and unhealthy reactions ater a person is exposed to a traumatic eent. 1he healthy
process also can be called Process o Integration o the experience into personality`.
69
! L".)/#; &):%$&/$:
Any disorder in which anxiety is the primary eature or in which anxiety appears when the indiidual tries to resist a phobia.
! P%%& &):%$&/$: D /:?/()677; &/?$/::)%"
Psychological disorders inoling intense and prolonged shits in mood. A person with a mood disorder might eel ery happy or ery sad or
long periods o time, and or no apparent reason. Because o this, their moods aect the way they perceie eerything in their daily lies, mak-
ing it ery di!cult to unction well. 1here are two main categories o mood disorders, Depressie Disorders ,major depression, dysthymia, and
Bipolar Disorders ,also known as manic depression, mood swings rom euphoria to depression,.
! Q%:#DN$6',6#)( 4#$/:: 1):%$&/$ RQN41S
An anxiety disorder based on a lasting response to a traumatic eent. According to DSM-IV, speci!c criteria must be met ,See Glossary,.

! 4%()67)C6#)%" #% 0)%7/"(/
Socialization is the process by which children learn during the early stages o their lie to adopt the behaior patterns o their parents or other
caregiers. In an insecure and brutal enironment, like in ciil war or within a amily with a lot o domestic iolence, indiiduals oten deelop
iolent and unsocial behaior patterns and are not engaged to deelop peaceul social skills.
! -.6(/$56#)%" %+ ?$/D/.):#)"A &):%$&/$:
A pre-existing disorder ,e.g. anxiety, mood disorder such as depression or substance abuse disorder, signi!cantly increases the risk o a subse-
quent exacerbation o this disorder ater being exposed to traumatic eents.
! P6K%$ 1/?$/::)%"
In a major depression, more o the symptoms o depression are present, and they are usually more intense or seere. A major depression can
result rom a single traumatic eent in your lie, or may deelop slowly as a consequence o numerous personal disappointments and lie prob-
lems.
! Q/$:%"67)#; &):%$&/$:
1hey orm a class o mental disorders that are characterized by long-lasting rigid patterns o thought and actions. Because o the in"exibility
and perasieness o these patterns, they can cause serious problems and impairment o unctioning or those a"icted with these disorders.

! 3%"0/$:)%" &):%$&/$
1his disorder is characterized by the loss o a bodily unction, or example blindness, paralysis, or the inability to speak . 1he loss o physical
unction is inoluntary, but diagnostic testing does not show a physical cause or the dysunction.
! 1)::%()6#)%"
1his is a psychological state or condition in which certain thoughts, emotions, sensations or memories are separated rom the rest o the psyche.
,See Glossary,.
! 1/?/$:%"67)C6#)%"
1his is the experience o eelings o loss o a sense o reality. A suerer eels that he or she has changed and the world has become less real ,See
Glossary,.
! Q:;(>%:/:
1his disorder is a generic psychiatric term or a mental state in which thought and perception are seerely impaired. Persons experiencing a
psychotic episode may experience hallucinations, hold delusional belies ,e.g., grandiose or paranoid delusions,, demonstrate personality changes
and exhibit disorganized thinking.
P/"#67 !77"/::/: E/:'7#)"A +$%, T6$ 6"& 1):?76(/,/"#
Victims o the Khmer Rouge year
isiting the 1oul Sleng Genocid
Museum in Phnom Penh
%!
21
Adapted rom: Daid Satcher et al. ,1999,: Chapter 4.2`, Mental health: A Report o the
Surgeon General, in: http:,,en.wikipedia.org,wiki...last isited on 19 lebruary 200.

%"
%&
%'
22
American Academy o lamily Physicans: www.amilydoctor.org ...last isited on 4 lebruary 200.
23
Adapted rom: National Institute o Mental lealth, Bethesda, USA: www.nimh.nih.go
%#
24
Baldwin, D.V. ,199,: Innoation, Controersy, and Consensus in 1raumatology . In: 1he International Llectronic Journal o Innoations in
the Study o the 1raumatization Process and Methods or Reducing or Lliminating Related luman Suering, Vol. 3:1, Article 3.
76
In their most seere orm, psychological and physical symptoms can accumulate to orm a condi-
tion known as Acute-Stress Disorder ,ASD, ,i the symptoms occur within the !rst our weeks
post-trauma,, or Post-1raumatic Stress Disorder ,P1SD, ,i the symptoms persist or longer than
one month,. 1hese conditions require proessional assistance and treatment.

Post-1raumatic Stress Disorder ,P1SD, is a real mental illness which is characterized by an emer-
gence o speci!c emotional, mental, somatic and behaioral symptoms in a distinctie combina-
tion and with a serious intensity and duration.
People may deelop P1SD ater liing through a ery rightening eent, or ater a series o right-
ening eents, like the Cambodian ciil war. 1hey hae oten gone through the traumatic stress o
witnessing killings, witnessing other atrocities, and liing in ear o iolence and death. Long ater
the traumatic eents hae subsided, people who deelop P1SD oten hae nightmares and scary
thoughts about the experiences they went through.
lor most people the symptoms o P1SD arise within about three months o the triggering
eent. lor some people the symptoms o P1SD don`t show up or years. It is ery important
or people with P1SD to stay away rom anything that reminds them o their traumatic experi-
ences.
It is not true that time heals all the wounds. Symptoms may
become less eident oer time, and more subtle, but in most
cases the suering will increase. Some people hae ery good
support rom their amily, good coping skills, and inner re-
sources, but despite this, untreated P1SD can cause a lot o
emotional and physical problems, such as psychosomatic reac-
tions. \ithout an adequate treatment many people may con-
tinue to hae P1SD symptoms een decades ater the trau-
matic eent.
11: What is Post-Traumatic Stress Disorder?
Post-Traumatic
Stress Disorder
(PTSD) is a term
for certain
psychological
consequences
of exposure to,
or confrontation
with, stress-
ful experi-
ences which
an individual
experiences
as highly
traumatic.
21
1reatment and aoiding treatment:
1hose who suer rom P1SD can get relie through a specialized treatment that includes psycho-
therapy and medication. P1SD is a long-term problem or many people. An estimated 40 percent
o people being treated or P1SD were still experiencing symptoms more than a year ater the
traumatic eent. Unortunately, it is common or those with P1SD to aoid treatment. \ithout
treatment, many people may continue to hae P1SD symptoms or decades ater the traumatic
eent.
People wish P1SD may experience eeling angry or
no reason, and an inability to trust or care about oth-
er people. 1hey are oten hyper-igilant, and seldom
eel secure. 1hey may be easily upset when something
happens suddenly or without warning.
21
Adapted rom: Daid Satcher et al. ,1999,: Chapter 4.2`, Mental health: A Report o the
Surgeon General, in: http:,,en.wikipedia.org,wiki...last isited on 19 lebruary 200.

77
M
M
L &)6A"%:): %+ Q%:#DN$6',6#)( 4#$/:: 1):%$&/$ $/U')$/: #>6# +%'$ ($)#/$)6 5/ ,/#8

1. 1he indiidual must hae been exposed to an extremely stressul and traumatic eent beyond
normal human experience.
2. 1he indiidual must periodically and persistently re-experience the eent. 1his re-experienc-
ing can take dierent orms, such as recurrent dreams and nightmares, an inability to stop
thinking about the eent, "ashbacks during which the indiidual relies the trauma, and audi-
tory hallucinations.
3. 1here is persistent aoidance o eents related to the trauma, and psychological numbing that
was not present prior to the trauma.
4. Lnduring symptoms o anxiety and arousal are present.
4;,?#%,: %+ QN41 ,6; )"(7'&/8
laing trouble sleeping.
Being irritable, angry or jumpy.
Being depressed.
Addiction problems ,abusing alcohol or drugs,.
laing "ashbacks, nightmares, bad memories, or hallucinations.
1rying not to think about the trauma or aoiding people who trigger those memories.
Not being able to recall parts o the eent.
leeling emotionally numb or detached rom others.
78
E/6(#)%": #>6# ,6; ?$/&)(# Q%:#DN$6',6#)( 4#$/:: 4;"&$%,/
! B76:>56(M:
Altered states o consciousness in which the indiidual beliees s,he is again experiencing the
traumatic eent. It is a type o spontaneous abreaction` o bad memories common to ictims
o acute trauma also known as intrusie recall` ,See Glossary,.
! N$6',6#)( &$/6,:
Dreams o particular intensity, with content that the sleeper !nds disturbing, related either to
physical causes, such as a high eer, or to psychological ones, such as unusual trauma or stress
in the sleeper`s lie.
! P/,%$; &):#'$56"(/:
! 4/7+D,/&)(6#)%"
A substitution with alcohol and drugs to compensate or "ashbacks and major emotional dis-
turbances.
! L"A/$2 )$$)#65)7)#;2 >%:#)7)#; G>)(> ): &)+"('7# #% (%"#$%7
! Q/$:):#/"# &/?$/::)%"
! 4%()67 G)#>&$6G67
People who
have anxiety,
depression or
other mental
disorders are
more likely to
develop PTSD.
People who
have been
victims of
previous
trauma are
also at greater
risk.
22
22
American Academy o lamily Physicans: www.amilydoctor.org ...last isited on 4 lebruary 200.
23
Adapted rom: National Institute o Mental lealth, Bethesda, USA: www.nimh.nih.go
Whether a person
develops
Post-Traumatic
Stress Disorder
may depend
partly on how
severe and
intense the
trauma was
and how long
it lasted.
Did you lie through rightening and dangerous eents during the Khmer Rouge years
Please check the box next to any problem you still hae:
# Sometimes, all o a sudden, I eel like it is happening oer again.
# Sometimes I hae nightmares and bad memories o the past.
# I stay away rom places and situations that remind me o the eent.
# I am easily surprised and eel ery upset when something happens without warning.
# I hae a hard time trusting or eeling close to other people.
# I get mad ery easily.
# I eel guilty because others died and I lied.
# I hae trouble sleeping and my muscles are tense.
I you put a check in the box next to all or most o these problems, you may hae Post-
1raumatic Stress Disorder.
23

79
! P1SD is a real illness that needs to be treated.
! It is not your ault, and with adequate treatment you won`t hae to suer oreer.
And:
! Most people in Cambodia who hae experienced the atrocities during the Khmer Rouge years
still hae some o the symptoms, but they didn`t automatically` or necessary get Post-1rau-
matic Stress Disorder. loweer , i they still suer rom symptoms o P1SD it would be help-
ul to get a psychotherapist`s or psychiatrist`s opinion.
N>/ #>$// ,6)" :;,?#%, (7':#/$: )" QN41 6$/8
!"#$':)%":, such as "ashbacks or nightmares, where the traumatic eent is re-experienced.
L0%)&6"(/, when the person tries to reduce exposure to people or things that might bring
on their intrusie symptoms.
<;?/$6$%':67, meaning physiological signs o increased arousal, such as hyper-igilance`
,See Glossary, or increased startle response` ,See Glossary,.
24

24
Baldwin, D.V. ,199,: Innoation, Controersy, and Consensus in 1raumatology . In: 1he International Llectronic Journal o Innoations in
the Study o the 1raumatization Process and Methods or Reducing or Lliminating Related luman Suering, Vol. 3:1, Article 3.
B76:>D
=6(M:
6"&
N$6',6#)(
1$/6,:
*!
82
\ith the help o counseling or couple-therapy interpersonal con"icts can be resoled
and destructie behaior pattern can be changed.
83
Besides anxiety and depression, suppressed or rozen anger is one o the primary emotional
responses to the traumatic eents in the recent Cambodian history, resulting in the prealence
o domestic iolence. 1he enironment in Cambodia is still ery insecure and high tension can
be elt throughout ciil society. 1raumatic experiences can be triggered at any time and a person
might be oerwhelmed with eelings s,he is unable to handle, i.e. anger. Len when unrecognized,
emotional trauma can create lasting di!culties in our closest relationships. Aside rom extreme
iolence, there are other destructie results o unhealed trauma, such as an inability to sole inter-
personal con"icts, lack o compassion and social withdrawal.
12: How Does Emotional Trauma Effect
Interpersonal Relationship?
Even when
unrecognized,
emotional
trauma can
create lasting
difculties in our
closest relation-
ships.
Some common eects o emotional trauma on interpersonal relationships:
Inability to maintain close relationships or choose appropriate riends and mates
Violent tempers, impulsie reactions
lostility
Arguments with amily members, employers or co-workers
Social withdrawal
Sense o being constantly threatened
Inability to sole interpersonal con"icts
Inability to listen and to concentrate
Lack o compassion and introspection
Lack o interest in communicating with
close, personal riends
Sexual problems
*#
*$
*%
**
*(
26
Adapted rom : International Organisation or Migration ,2006,, Module 6: Mental lealth, Phnom Penh: IOM
()
2
Lrikson, L. ,1963,: Childhood and society, New \ork: Norton
(!
92
28
Loung Ung, 2005, Lucky child. A daughter o Cambodia reunites with the sister she let behind, New \ork: larper, p. 123-124.
93
lrom the !rst day o their lie, all children hae to struggle with their own deelopmental tasks,
with the normal limitations o their parents, and with the destructie human behaior in their
social world. Len in so called times o peace`, daily interactions with tension and unhealthy pat-
terns in their personal and material enironment hae the potential to cause a number o mental
health problems. 1hese psychological and social actors may be exacerbated by biological actors
like genetic predisposition, anatomical abnormalities, or neurological problems.
In times o war, ciil war, or other man-made disasters`, children tend to be exposed to extreme-
ly oerwhelming stimuli that may lead to suering and speci!c mental health problems. Some
children hae a seere reaction to trauma, which is similar to the symptoms o Post-1raumatic
Stress Disorder ,See Chapter 11,.
13: What Are Mental Health Problems of Children,
Which Emerge and Are Caused by Traumatic Events?
Each traumatized
child will have
his or her own
experience
and reaction
to trauma.
Lach traumatized child will hae his or her own experience and reaction to trauma.
Despite their extreme ulnerability, children hae ery speci!c coping strategies, which protect
them rom the impact and threat o atrocities in their enironment. Children with this ability
create their own inner world, enriched with idealized persons, powerul beings, guardian angels,
and airy-tale !gures.
\ithin this inner world they are able to create a sae place where the traumatic eents lack the
power to destroy their trust in lie and in the people they are dependent on. loweer, this cop-
ing strategy also is ery ragile, and nothing can guarantee that it will preent a child rom su-
ering rom psychosomatic symptoms, grie, or een mental health disorder.
25
25
Discussions with Dorsch \itzel, R., 1rauma-therapist and Children-therapist, Zuerich 2006
94
Children will oten respond to trauma with the same symptoms as adults, but because their per-
ception o the world is dierent, and because they cannot understand the traumatic eents as
adults sometimes do, they may respond more ulnerably and spontaneously.
Like adults, many children do not like to talk about their traumatic experiences. Very oten they
are araid to share their eelings, especially i close relaties are inoled, because they might eel
guilty or their ailure to preent the traumatic eent and to preent the suering o their parents
and siblings. 1his can een occur in response to an eent as great as a ciil war.
N>%:/ G>% /.?/$)/"(/& %$ G)#"/::/& #$6',6#)( /0/"#: )" #>/)$ (>)7&>%%& 6$/ 6# )"D
($/6:/& $):M +%$ 6 >%:# %+ ?:;(>%7%A)(67 ?$%57/,:2 ),?6(#)"A 677 6$/6: %+ +'"(#)%")"AH
B%$ /.6,?7/8
Impaired emotional, social, cognitie, and physiological unctioning.
Issues such as teenage pregnancy, adolescent drug abuse, ailure in school, ictimization
and anti-social behaior.
Medical problems, such as heart disease and asthma. Childhood trauma has also been
linked to increased risk or cigarette smoking.
A higher incidence o neuropsychiatric conditions, such as Post-1raumatic Stress Disorder,
Dissociatie Disorder, and,
A higher incidence o domestic iolence.
1he incidence o domestic iolence in child suriors o trauma is particularly troubling.
lor boys, witnessing iolence as a child greatly increases the chances that they will grow up
to act iolently with their partners. lor girls, it increases the chances that they will accept
iolence in her dating and,or marital relationships. Children who grew up in iolent eni-
ronments are intensiely taught that iolence is an eectie way to gain power and control
oer others. 1hus, children rom iolent homes are more prone to accept excuses or io-
lent behaior, and are at increased risk o acting aggressiely toward their peers and adults.
95
VH W/$; ;%'"A (>)7&$/" R6A/: XDYS8
lear o being separated rom their parents
Problems sleeping alone in their beds
lear o darkness
lear o strangers
Regression to earlier deelopmental stages ,so-called regressie` behaiour, such as thumb-
sucking or bedwetting,
Children will typically suffer and respond to traumatic events with the
following symptoms:
ZH [)"&/$A6$#/"D 6"& 4(>%%7 (>)7&$/"8
Dissociation` ,Becoming physically and,or psychologically disconnected with one`s expe-
riences during traumatic eents - See Glossary,
Disruptie and aggressie behaior
\ithdrawal
Irritability
Inability to pay attention or concentrate
Somatic complaints and bodily symptoms
Sleeping problems and nightmares ,See Glossary,
Re-experiencing the trauma during play or dreams
Recreating the traumatic scene in play-time scenarios
Children who
grew up in
violent
environments
are intensively
taught that
violence is an
effective way to
gain power and
control over
others.
96
\H L&%7/:(/"#:8
Dissociation` ,Becoming physically and,or psychologically disconnected with one`s experi-
ences during traumatic eents - See Glossary,
llashbacks ,See Glossary,
Social withdrawal
Depression
Aoidance o any stimuli that are closely related to the traumatic experience ,traumatic triggers
- See Glossary,.
Sel-medication` with alcohol and drugs to compensate or "ashbacks and major emotional
disturbances
Other symptoms like adults ,See Chapter 9,
26
During childhood eery indiidual must successully naigate a series o psychosocial stages.
At each stage, a particular deelopmental challenge ,a so-called crisis or con"ict, comes into o-
cus. Although each con"ict neer completely disappears, it needs to be su!ciently resoled at a
gien stage i an indiidual is to cope successully with the con"icts o later stages. lor example
.ri/.ov
2
identi!ed eight stages in the whole lie cycle o an indiidual. le identi!ed !e stages
until adolescence and, as shown in ligure 13.1, at each stage a particular deelopmental crisis
comes into ocus:
26
Adapted rom : International Organisation or Migration ,2006,, Module 6: Mental lealth, Phnom Penh: IOM
ligure 13.1.: lie psychosocial stages o the childhood with the particular deelopmental challenges o each stage,
adapted rom Lrikson ,1963,.
2
Lrikson, L. ,1963,: Childhood and society, New \ork: Norton
97
In his !rst proposed stage an inant needs to deelop a basic sense o trust in his or her eniron-
ment through interaction with caregiers. 1rust is a natural accompaniment to a strong attach-
ment relationship with a parent who proides ood, warmth, and the comort o physical close-
ness. But a child whose basic needs are not met, and,or who experiences inconsistent handling,
lack o physical closeness and warmth, and the requent absence o a caring adult, may deelop
a perasie sense o mistrust, insecurity and anxiety. During the Khmer Rouge time, young chil-
dren`s basic needs were oten unul!lled, resulting in an inadequate deelopment o a basic sense
o trust.
\ith the deelopment o walking and the beginning o language in the second stage, there is
an expansion o a child`s exploration o objects and people. \ith these actiities should come a
comortable sense o autonomy and sense o being a capable and worthy person. Lxtensie re-
strictions, which are common in times o war and staration, may lead to seere sel-doubts.
Children, who grew up during such times o permanent insecurity and lack o warmth - like
during the Khmer Rouge time - may not resole adequately this crisis or the crisis associated
with the next ,third, etc., phases o deelopment. \hen preious crises are let unresoled, as-
pirations remain unul!lled, and the indiidual experiences utility, despair and sel-depreciation.

During the
Khmer Rouge
time, young
childrens ba-
sic needs were
often unfullled,
resulting in an
inadequate
development of
a basic sense of
trust.
Extensive
restrictions,
which are
common in
times of war
and starvation,
may lead to
severe
self-doubts.
98
.Ater dinner, we all moe to the liing room. Meng and Lang sit on the couch while
Maria plays with a doll between them. I`m lying on my side on the "oor, when the trailer
or 1he Killing lields splashes across our 1V screen. 1he commercial begins with a group
o helicopters "ying into iew like a swarm o dragon"ies, then cuts to scenes o bombs
dropping onto Cambodia, and the Khmer rouge soldiers storming into Phnom Penh.

lrom somewhere inside my brain, the smell o putrid "esh leaps o
the teleision and !lls my nostril. I blink but the smell remains and
attacks my eyes, making them water. My scalp starts to sweat, while
my heart squeezes into a tight !st. Lightly, I scratch my eet and crack
my toes to distract mysel rom the smell. Americans won`t remem-
ber the smell, the sound, or the heat. lor two hours they`ll sit in the
dark and watch but they`ll neer know what it was like to be there
or three years, eight months and twenty-one days. \hat it was like
thinking eeryday that I was going to die and not knowing i the war
would eer end. \hen the credits roll ater two hours, the lights will
come back on, and they`ll leae the war. But I can`t. I shit my eyes
to the corner o the liing room without moing my head. I don`t
want Meng and Lang to see how upset and worry that I still eel and
remember. I hae to be strong because i I let mysel cry, Im araid
I`ll neer stop. So I orce my body to be still while the actors dressed
in black cry and scream.` Loung Ung
28
Loung Ung, Author o the book
lirst they killed my ather`
28
Loung Ung, 2005, Lucky child. A daughter o Cambodia reunites with the sister she let behind, New \ork: larper, p. 123-124.
((
!)!
29
Lichtmann, l. ,1984,: Parental communication o lolocaust experiences and personality characteristics among second-generation suri-
ors. Journal o Clin. Psychol. , Vol.4: 914-24.
30
ibid
!)"
(
)
(
31
OM Chariya ,2006, : Bachelor 1hesis. Childrens perception o Parental 1rauma on their perceied care and oerprotection, Phnom Penh:
Unpublished Document.
32
KIM 1hida ,2006, : Bachelor 1hesis. Role Reersal o 1raumatic Parents rom Khmer Rouge Regime, Phnom Penh: Unpublished
Document.
!)&
104
Understanding the role o parental trauma can help to improe indiidual unctioning as well as
unctioning within the amily.
29

Such studies show that children who perceied their parent`s anguish and responded to it with
empathy or oer-identi!cation experienced trauma symptoms, such as intrusion, aoidance, and
hyperarousal. In addition, children who saw their parents as hyperigilant and socially mistrusting
responded with their own leels o hyperigilance and mistrust. linally, children whose parents
communicated about their traumatic experiences in an open manner were ound to experience
less oerall P1SD and ewer symptoms o aoidance than those whose parents were silent about
their past experiences.
30

Most children who lied in the Khmer Rouge era did not get adequate physical and emotional
care, as their parents were not able to spend the time and energy required to ul!l their needs. lor
example, one o the most important needs o a young child is to eel secure and to be able to !nd
a sae place i they are scared. But during the Khmer Rouge regime parents lied permanently
under the threat o being punished, being separated rom their amilies, or being killed. 1hus, they
were unable to proide the peaceul and relaxed atmosphere children need to grow up healthy.
Also, many children were taken away rom their amilies and orced to lie in children`s camps,
where nobody took care about their psychological and physical needs.
Another issue is that, in some cases, children think that their parents do not loe them i they are
not there to protect them or oer explanations.
1he oerprotectie education patterns o the parents toward the child are signi!cant obstacles or
the children`s ability to deelop independence and grow up without unhealthy behaior patterns.
31
Research in Cambodia also reealed that there is a signi!cant correlation between oerprotectie
and role reersing mothers ,tendency o the mother to unconsciously in"uence their children
to ul!ll her own needs rather than being aware o the needs o her children and ul!lling her
children`s needs adequately, and psychological problems o the children, such as depression and
anxiety.
32

14: Is It Possible for Trauma Symptoms to Be
Transmitted to the Second Generation?
Studies on children o trauma suriors hae ound some eidence that the trauma symptoms rom !rst generation
trauma suriors are oten passed down to their children.
36,5%&)6" ,%#>/$:2 G>% G/$/ #$6',6#)C/& &'$)"A #>/ [>,/$ E%'A/ ]/6$:
tend to be oerprotectie o their children
tend to unconsciously in"uence their children to ul!l their own needs rather than being
aware o the needs o their children and instead o ul!lling such needs
tend to ail to ul!l the deelopmental needs o their children.
Children who
saw their
parents as
hypervigilant
and socially
mistrusting
responded
with their
own levels of
hypervigilance
and mistrust.
29
Lichtmann, l. ,1984,: Parental communication o lolocaust experiences and personality characteristics among second-generation suri-
ors. Journal o Clin. Psychol. , Vol.4: 914-24.
30
ibid
31
OM Chariya ,2006, : Bachelor 1hesis. Childrens perception o Parental 1rauma on their perceied care and oerprotection, Phnom Penh:
Unpublished Document.
32
KIM 1hida ,2006, : Bachelor 1hesis. Role Reersal o 1raumatic Parents rom Khmer Rouge Regime, Phnom Penh: Unpublished
Document.
In some cases,
children think
that their par-
ents do not love
them if they
are not there to
protect them or
offer explana-
tions.
105
3>)7&$/" %+ 36,5%&)6" ?6$/"#:2 G>% G/$/ #$6',6#)C/& &'$)"A #>/ [>,/$ E%'A/ ;/6$:8
tend to o oer-identiy with their parents` trauma
experience a signi!cant amount o their own trauma symptoms, including intrusion, aoidance, and
hyperarousal
see their parents as hyperigilant and socially mistrusting, and respond to this with their own leels o
hyperigilance and mistrust.
!)%
!)*
33
Rl Mollica, R.l., \yshak, G., Laelle, J.,198,: 1he psychosocial impact o war trauma and torture on
Southeast Asian reugees . Am J Psychiatry 198, 144:156-152.
34
Lxperiences o the author during his work as a psychotherapist at the Psychiatric Uniersity lospital in
Switzerland.
!)(
!!)
111
It is important to emphasize that not all suriors o traumatic eents respond to their experi-
ences in the same way. \hile some Khmer Rouge suriors deeloped serious mental health is-
sues due to the pain, deastation and loss they experienced, others say that liing through these
traumatic eents also made them re-ealuate their priorities in lie ,acquire new alues, and change
their liestyles, thus bringing about substantial change and renewal in their lies. 1his doesn`t mean
that such people neer had symptoms such as nightmares, sleep disturbances, or sudden outbursts
o grie and sadness.
Although there hae not been any comprehensie studies o suriors o the Khmer Rouge
in Cambodia, a study o Cambodian reugees who resettled in the United States reealed
that 62 suered rom Post-1raumatic Stress Disorder ,P1SD, and 51 rom depression.
33


15: Why Did the Khmer Rouge Years Cause Emotional
Trauma in Some People and Not in Others?
ligure 15.1: 1he quality and the result o indiidual inner-psychic ealuation processes is ery impor-
tant. Consciously and,or unconsciously, a person realizes whether he or she lacks adequate coping
strategies. 1he results o the ealuation processes in"uence emotionally and physically the quality o
physical and psychological tensions and the indiidual`s perception o suering.
33
Rl Mollica, R.l., \yshak, G., Laelle, J.,198,: 1he psychosocial impact o war trauma and torture on
Southeast Asian reugees . Am J Psychiatry 198, 144:156-152.
112
Lery person in Cambodia who lied through the Khmer Rouge atrocities responded with im-
mense and oten endless grie, anger and deep suering.
\hether a person will respond with prolonged traumatic symptoms or with normal emotional
reactions during a process o integrating traumatic eents depends on seeral actors, including
the indiidual`s ability to cope with the traumatic eent.
1his applies not only to ictims o the Khmer Rouge regime, but also to perpetrators. Case
studies rom therapists hae shown that perpetrators oten deelop strong tendencies and pat-
terns o memory suppression, numbing o their eelings and other kinds o unconscious coping
mechanisms. 1he result is that they oten suer less consciously and eel depressed less oten than
ictims, and thereore ail to deelop healthy compassion.
34

It is likely that many actors are inoled in explaining why responses to traumatic eents are so
dierent in dierent people. Much o the ariation relates to the arious circumstances and per-
sonalities inoled.
Whether a
person will
respond with
prolonged
traumatic
symptoms or
with normal
emotional
reactions
during a
process of
integrating
traumatic
events depends
on several
factors,
including the
individuals
ability to cope
with the
traumatic
events.
34
Lxperiences o the author during his work as a psychotherapist at the Psychiatric Uniersity lospital in
Switzerland.
ligure 15.2: 1he results o this indiidual ealuation processes ,thinking and awareness processes, are dependent on:
e.g., ormer positie or negatie experiences, many personality actors such as thinking pattern , positie or negatie
thinking tendencies, or the extent o anxiety, the anticipation o the uture, and the ealuation o the actual situation
,See picture on page 5,.
113
4%,/ +6(#%$: &/#/$,)")"A &)++/$/"# $/:?%":/: #% #$6',6#)( /0/"#:8
3)$(',:#6"(/: G>)(> ,6; )"!'/"(/ %$ )"#/":)+; #>/ $/:?%":/

4#65)7)#; 6"& :/('$)#; %+ #>/ :%()%D?%7)#)(67 (%"#/.# ,e.g., during KR years: Ciil \ar, ear
o authorities, suspicion o ellow illagers,.
4/0/$)#; %+ #>/ /0/"#: ,KR years can be described as extreme traumatization`,
1'$6#)%" %+ /.?%:'$/ to traumatic eents ,the KR years were a prolonged exposure or
many people,
4)#'6#)%" %+ ?//$ A$%'? %$ +6,)7; ,during KR years people were in a state o permanent
ear, amilies were torn apart, there were spies in the neighborhood,
4'??%$# +$%, +6,)7;2 +$)/"&:2 6"&^%$ ?$%+/::)%"67: ,during KR years there was no pro-
essional support aailable, and little support rom amily members because eerybody was
struggling with the same situation, but sometimes, amily members gae heroic support to one
another.
L((/:: #% :'??%$#)0/ 6"& :/('$/ (%"#/.#: ,during KR years: no adequate access to hospi-
tals, or sae places to relax, rebalance, regain inner peace, but in some cases: amily members,
riends and illagers helped to create a healthy atmosphere.
L:?/(#: %+ Q-E4_OL9!N] G>)(> ,6; )"!'/"(/ %$ )"#/":)+; #>/ $/:?%":/

N>/ )"&)0)&'67@: ?/$:%"67 >):#%$;8 e.g., whether a person grew up in a healthy, emotion-
ally stable, and supportie social context, whether a person deeloped a balanced personality,
whether they receied inner strength rom his or her ormer lie experiences, whether s,he
learned to be "exible and to adapt quickly to changes in circumstances.
!"&)0)&'67@: ?/$:%"67)#; ?6##/$"8 e.g., whether the person was emotionally stable beore the
eent, was a relaxed and balanced person, was a person who neer gae up, was someone who
could gain trust rom other people.
W67'/: 6"& 5/7)/+: >/7& 5; #>/ )"&)0)&'678 e.g., whether the person had deep
general trust in lie, had inner strengths deeloped through Buddhist or other reli-
gious and spiritual approaches, had aith in oercoming horrible eents, possessed
the motiation to seek relie een where the situations seemed hopeless.
3%?)"A :M)77:8 e.g., ability to manage extreme situations, surial techniques, good
instincts, ability to deal with di!cult and oerwhelming eelings, and to manage
anger, sadness, grie, ability to anticipate the thoughts and behaior patterns o the
perpetrators, ability to keep inner distance rom the oerwhelming eents, ability
to maintain mental control, ability to dissociate or a while ,creating a supportie
inner world, leaing` the body, numbing,.
,See picture on page 5,
Lack o adequate coping skills
Coping skills
are behavioral
tools used by
individuals to
deal with
stressful
situations.
!!#
!!%
!!*
35
loa, L.B.,199,: Physiological processes related to recoery rom a trauma and an eectie treatment or P1SD. In: \ehuda, Mclarlane, 199:
p.416.

!!(
36
!")
3
Model translated and adapted or the Cambodian context rom: Butollo, \.al. ,1999,: Kreatiitt und Destruktion posttraumatischer
Bewltigung, Stuttgart: Peier, p.185.
!"!
!""
!"&
124
16. Is Psychotherapy Necessary and/or Appropriate
in Cambodia?
1wo conditions should motiate people in Cambodia to seek proessional support:
1. 1hey are suering permanently rom speci!c symptoms, such as nightmares, psychosomatic symp-
toms, depression, or anxiety.
2. 1hey are suddenly oerwhelmed by "ashbacks, or traumatic eents are triggered by reminders in daily
lie, or example, seeing young people wearing clothes with the same black color as the clothes o
Khmer Rouge soldiers.
Psychotherapists know that the healing process cannot wipe out the cause or most o the impact
o a suering soul. 1hey know that they cannot guide a traumatized person to orget all o their
grie and pain, and cannot erase their traumatic experiences. But a sustainable healing process
proides indiidual skills or indiiduals to lie with the trauma they hae experienced and rec-
ognizes each indiiduals own eorts to surie the trauma with dignity. 1hereore, the realistic
aims o trauma therapy are to help clients to regain con!dence, sel-esteem, dignity, and hope,
and to proide proessional support to deelop skills to accept the conditions and realities o the
person`s lie. lelping people !nd a positie sense o their lie, despite their extreme suering,
and to reconnect people with their deepest and most beautiul sources o their personalities is
a prominent ocus o psychotherapy and counseling. loweer, there is no guarantee that these
results will be achieed in eery case.
Realistic aims
of trauma
therapy are to help
clients to regain
condence,
self-esteem,
dignity, and hope,
and to provide
professional
support to
develop skills to
accept the
conditions and
realities of the
persons life.
1his person needs proessional help and,or
adequate support rom his social network.
125
Beore talking more concretely about therapeutic trauma approaches within the Cambodian
context, it is useul to emphasize the ollowing conditions:
! An uniersally alid trauma approach does not exist. 1hereore is no one general approach` in
treating trauma ictims that indiidual therapists should acknowledge or embrace.
! 1he knowledge about deelopment and processes o trauma, especially brain processes with
their implication or the human behaior is still limited, een a huge amount o research is
permanently published.
! Lery cultural context, eery speci!c situation and particularly eery indiidual person requires
an indiidualized treatment, because o their own character. 1here are as many approaches to trau-
ma therapy as there are trauma therapists or counselors. .
! 1his means that eery single trauma therapeutic process has his own unpredictable dynamic
because o the unique interaction o the speci!c persons coming together as client and thera-
pist.
! 1his requires that we exercise caution around making generalized comments about the pos-
sibilities, limitations and technical approaches related to an adequate treatment o trauma.
Neertheless, an approach appreciating these preconditions and the speci!c cultural context o
Cambodia should integrate the considerations discussed below.
A sustainable
healing process
provides individual
skills for
individuals to live
with the trauma
they have
experienced and
recognizes each
individuals own
efforts to survive
the trauma with
dignity.
1he main approach o therapists all oer the world is to guide their suering clients to new healthy experiences, because these
new experiences may hae the power to oerride the prior traumatic experiences o trauma and help their clients regain inner
peace. In this process, therapists talk with clients intensiely about the details and the eelings o their experiences during the
past eents. 1his re-experiencing within a healthy and secure atmosphere oten has the power to proide relie, or example
due to the ollowing eects:

1. Clients will be engaged to oercome their speechlessness and numbness. 1hey will regain the ability to express themseles
in a more open, precise, relaxed and trustul way.

2. 1hey will be aware and reconnected with their reeze` eelings and will be guided through deep grie and sadness. Because
this coincides with the sae atmosphere, compassionate presence and authentic resonance o the therapist, it urthers the
healing process.

3. Clients get speci!c skill training to perceie the dierence between the state o helplessness within the traumatic experience
o the past and the ability to hae control` in the present ,be able to unction consciously,, een i "ashbacks rom the
past start to oerwhelm the indiidual with painul eelings and thoughts. lor example, clients learn to relax deeply and to
intentionally ocus on the reality o the present ,lere and now there is no ciil war`, lere and now I am secure`, lere
and now I can trust people`,.

4. Clients are empowered to perorm their daily lie in a more balanced manner. 1hereore, they will gain skills to reconnect
with their sources, their creatie potentials and their power.
126
Len in light o theses bene!ts, we hae to acknowledge some potentially problematic side
eects. As we know rom recent brain research, we hae to be ery careul with any therapeutic
approach. Len i it is helpul to gie traumatized people the opportunity to share their suering
within a healthy and secure setting, it can sometimes trigger ery intense eelings. 1he trauma o
the treated person could become worse i the treatment is only ocused on storytelling` and does
not add a speci!c process to address the trauma. 1herapists know that our brain cannot dierenti-
ate between a real traumatic eent and a comprehensie imagination o a traumatic eent. 1hey
know rom research about mental health that a sustainable healing process has to approach new
and correctie` experiences ,to correct the old, unhealthy experiences,. Otherwise, the human
brain will react with the same coping strategies as i the person would experience the traumatic
eent repeatedly. 1his is not supportie or the healing o a suering soul. 1he act is that without
a real correctie experience, there is no healing process.
An appropriate trauma treatment approach includes the ollowing interentions:
Lducation about common reactions to trauma, breathing retraining, prolonged, repeated exposure to memory ,reliing,,
and repeated in io exposure to situations the client is aoiding because o assault-related ear.
35

1hereore, it is undamental that a treatment be related to the results o brain research and
employ approaches, such as relaxation, reconnecting clients with their sources, learning additional
coping strategies, and speci!c techniques like Lye Moement Desensitization and Reprocessing`
,LMDR,
36
, Screening techniques` , Learning to take control oer your rightening thoughts,
imaginations and "ashbacks, and other new methods. A storytelling approach, which does not
integrate these psychological methods could be problematic.
35
loa, L.B.,199,: Physiological processes related to recoery rom a trauma and an eectie treatment or P1SD. In: \ehuda, Mclarlane, 199:
p.416.

36
LMDR - Lye Moement Desensitization and Reprocessing is a tool used in certain orms o psychotherapy that intends to reliee the symp-
toms o post-traumatic stress disorder ,P1SD, and other mental health problems using eye moements similar to those which occur naturally
in RLM sleep. 1his eye moements seem to stimulate the memory network where the trauma is stored. 1he eye moements may also actiate
the inormational networks that can restore a traumatized person`s ability to process an eent ully. \hen both networks operate simultane-
ously during the eye moement sets, it appears that the traumatic inormation is rapidly processed.
37)/"#: G)77 5/ 6G6$/ 6"& $/(%""/(#/& G)#> #>/)$ F+$//C/I +//7)"A: 6"& G)77 5/
A')&/& #>$%'A> &//? A$)/+ 6"& :6&"/::H N>/; G)77 5/ /"A6A/& #% %0/$(%,/
:?//(>7/::"/:: 6"& "',5"/::H N>/; G)77 $/A6)" #>/ 65)7)#; #% /.?$/:: #>/,:/70/:
)" 6 ,%$/ %?/"2 ?$/():/2 $/76./& 6"& #$':#+'7 G6;H
A sustainable
healing process
has to approach
new and
corrective
experiences.
127
ligure 1.1: An example o a psychotherapeutic trauma treatment approach with our stages
3
:
1his model starts rom the assumption that comprehensie trauma treatment should include
conrontation with the traumatic experiences and the traumatic changing. 1his approach pro-
ceeds rom the assumption, that an emotional conrontation with the irreersibly results o the
lie changing caused by traumatic eents supports the healing process. 1his last assumption is
controersial within the scienti!c community. loweer, the !rst, second, and ourth stage o this
model, ,1, perceiing and consolidating security, ,2, perceiing and oercoming instability and ,4,
acceptance o trauma and acceptance o the new lie circumstances are part o all modern trauma
therapy approaches throughout the world.
Here in Cambodia we have to focus on stages one and two in particular: It is perceivable,
not only for well-trained diagnosticians, that Cambodians with past-traumatic experiences
feelings of insecurity, and rarely trust themselves and others. Despite the relatively secure liv-
ing standard, one could assume that many Cambodian's behavioral patterns reects that they
are still living in a survival mode.
The issue becomes how to stabilize people, when the socio-political situation is so unstable
and the lives of Cambodians are lled with so many instabilities.
3
Model translated and adapted or the Cambodian context rom: Butollo, \.al. ,1999,: Kreatiitt und Destruktion posttraumatischer
Bewltigung, Stuttgart: Peier, p.185.
128
Figure 16.1.: Healing and protective factors of a psychotherapeutic process
38
38
See also: Petzold, l., et al., Integratie 1raumatherapie. Modelle und Konzepte r die Behandlung on Patienten mit posttraumatischer
Belastungsstorung ,Integratie trauma therapy. Models and concepts or the treatment o patients with P1SD,. In: Van der Kolk, B.A. et al.,
1raumatic stress. Paderborn: Junermann, p.499.
An understanding o rudimentary trauma healing concepts is especially necessary in the Cambo-
dian context. In 2008, there are ar too ew quali!ed trauma therapists in Cambodia. 1hus, it is
crucial that social workers and other NGO sta who deal with traumatized persons hae a basic
understanding o trauma, healing techniques, and therapeutic approaches discussed in this book.
Only then can trauma be managed and the healing-process begin.
Access to appropriate support and healing approaches is or eeryone.
1here is no reason or shame since trauma symptoms are neither a sign o character weakness nor a
reason to be depreciated.
Lach trauma is always two-sided, een i the constructie side is more hidden.
lealing and reconciliation requires indiidual engagement.
!
"
#
$
%
&

(
)
*

$
+
,
&
-
.
)
%

-
&
#
"
/
0
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-
1
129
ESSENTIALS
A diagnosed trauma client in need o counseling or psychotherapy must work closely with
his,her therapist to conceptualize and create an indiidualistic approach because each client is
unique and has speci!c needs requiring indiidualized therapeutic aims and strategies.
In creating this therapeutic ramework, the therapist must utilize !"#$%&$'(% *+&$#", ,identi!ed in
the graphic aboe,, the !,-&.#/#0'&+/ "%,'/'%1&% o the client and to minimize "',2 *+&$#", ,such
as weak social networks, negatie aluations and negatie sel-image, and lack o resources,.
1he lealing process inoles elements that build trust, promote a eeling o security, promote
sel-awareness, and help the indiidual reintegrate into society.
\ithout these therapeutic elements traumatized people cannot be healed rom their oten huge
and unconscious lack o trust in onesel, in lie and in others. Absent these essential therapeutic
actors, reconciling ones own history, loing onesel and other liing creatures can neer be
accomplished.
In such matters, therapeutic aims are oten analogous to many religious approaches, i.e., spiritual
growth.
Psychological
resilience
refers to an
individuals
capacity to
withstand
stressors and
destructive
stimuli, and
not manifest
psychological
dysfunction .
39
39
1his de!nition o resilience results rom personal therapeutic experiences o the author
40
1he author`s experiences rom long-term therapeutic processes, with multiple traumatized patients ,Drug addicted people, tortured politic
prisoners, abused children,.
VX :#/?: #%G6$&: >/67)"A +$%, #$6',6
YX

R"%# ,/6"# #% 5/ 6 7)"/6$ ?$%(/::S
VXH Q$%0)&)"A $/:%'$(/: 6"& :M)77: +%$ $/)"#/A$6#)"A )"#% &6)7; 7)+/H
`H a/"#7; /.?%:)"A #>/ #$6',6#)( /.?/$)/"(/: 6"& $/(%"()7)"A G)#> #>/ ?6:#H
bH 1/0/7%?)"A #$':#H
cH 1/0/7%?)"A )""/$ :/('$)#;H
dH 1/0/7%?)"A #$':#H
eH 1/0/7%?)"A )""/$ :/('$)#;H
YH 1/0/7%?)"A #$'#H
\H 10/7%?)"A )""/$ :/('$)#;H
ZH 1/0/7%?)"A #$':#H
VH 1/0/7%?)"A )""/$ :/('$)#;H
!&!
38
Van der Kolk, B. et al. , 2000,: 1raumatic Stress, Paderborn: Junermann, p.18.
39
KAIROS: Philosophical technical term rom Greek language: It means the absolute right moment, the time-window` when a particular
deelopmental step is possible to be done
1raditional Cambodian approaches to help people who are suering rom traumatic eents.
!&"
40
Malkani, V. ,2002,: Lnlightenment made simple. Understanding man`s quest or diinity. India: New Dawn Press, p.144.
!&&
Religious belies to bring peace into the hearts o Cambodians
134
1he way that ictims o trauma are treated in a society is an indication o that society`s attitude
towards and appreciation o its citizens in general.
38
Along with other deeloping countries, Cam-
bodia in particular still has to learn the basics about the impact, and especially the long-term
results, o trauma, as well as the ability o ictims to regulate their physical and psychological ho-
meostasis. 1his requires the realization and acknowledgement that een years ater a traumatizing
eent - or example, thirty years ater the Khmer Rouge atrocities - the memory o such an eent
continues to dominate the mind and the behaior o those who experienced it. Consequentially,
those responsible or Cambodian society hae to learn how to support these ictims and to help
them regain power and ownership oer their lies.
I this doesn`t happen in an appropriate time rame, oten described as the K.RO
39
, it will
inhibit the healthy and humanistic deelopment o the whole country. But what is the appropri-
ate time rame Certainly, oreign specialists must be careul in de!ning the right moment, and
not push deelopment. But Cambodians, too, should hae an understanding o the K.RO and
realize that there is a need or a nationwide healing process in order to heal the hearts o many
Cambodians. \ithout this consciousness, a sustainable process o reconciliation is not possible.
1he process o healing and gaining peace in one`s heart most likely entails the same problems`
as attaining spiritual enlightenment:
Once a man came up to Buddha and asked him: Yov /vor, bare beara ,ov vav, tive., ava erer, tive
,ov tett v. tbat evtigbtevvevt i. o..ibte for att of v.. vt barev`t .eev av,boa, bere get evtigbtevea. vaaba
retiea, Do ve a faror. v tbe erevivg, toaa,, go to erer, bov.e iv tbi. rittage - to tbe vev of tbe bov.e - ava
a./ biv rbat i. it tbat be ae.ire.. 1be vav revt arovva iv tbe erevivg, to erer, bov.e iv tbe rittage, ava tbe
fottorivg vorvivg, be ra. bac/ ritb vaaba. vaaba a./ea biv to reaa tbe ti.t of ae.ire.. 1be vav .tartea
reaaivg: ov.e vvvber ove, bi. ae.ire. are to acqvire tava, to varr, bi. aavgbter ivto a ricb favit,, to a.. ov
tava ava vove, to bi. .ov.. ov.e vvvber tro, tbe vav`. ae.ire. are .o ava .o. ^ot iv av, of tbe.e bov.e. ba.
av,ove .aia tbat be ae.ire. evtigbtevvevt. vaaba tbev tota biv, bare tota ,ov tbat evtigbtevvevt i. o..ibte
for att of v., ava it i.. vt bor vav, of v. reatt, ae.ire it.
40

lortunately, trauma issues are now receiing attention by young psychologists, social workers and
others who eel deeply concerned about the mental health situation in Cambodia. In the near
uture these compassionate citizens will surely pass this knowledge on to the rest o society be-
cause o their commitment to progress in the science o trauma. lor example, there is increased
awareness among these indiiduals that being exposed to traumatic eents may hae seere and
long-term impacts such as changes o the regulation o stress hormones, or permanent changes
within the endocrine system as well as in the unction and structure o certain areas o the brain.
Recognizing this and other phenomenon is a necessary precondition to understanding the seere
impact o such widespread unhealed trauma on the peace o the hearts` o indiiduals and on
the process o reconciliation in Cambodia.
Epilogue
38
Van der Kolk, B. et al. , 2000,: 1raumatic Stress, Paderborn: Junermann, p.18.
39
KAIROS: Philosophical technical term rom Greek language: It means the absolute right moment, the time-window` when a particular
deelopmental step is possible to be done
40
Malkani, V. ,2002,: Lnlightenment made simple. Understanding man`s quest or diinity. India: New Dawn Press, p.144.
135
Now that we hae highlighted the basic psychological concepts about trauma in Cambodia in the
present publication, we will ocus on incorporating more practical applications how to support
Cambodians who suer rom trauma in our second handbook. Readers will !nd inormation
related to issues such as:
\hen is it necessary to seek proessional help
\hat can therapists do to help dierent target groups o traumatized people in Cambodia
\hat can people do to support their amily and riends who suer rom trauma
One o the major messages o the second publication will be: Nobody needs to eel ashamed,
guilty or weak or asking or help. Lerybody has the right to seek help i s,he need it.
!&$
!&%
!&*
41
DSM-IV, Diagnostic and Statistical Manual o Mental Disorders, 4th Ldition, published by the American
Psychiatric Association, USA ,2000,.
!&(
140
3%,?7/. N$6',6 %$ 3%,?7/. QN41 ,See also: P1SD,: Is best understood as a condition that
results rom prolonged exposure to prolonged social and,or interpersonal trauma ,e.g., physi-
cal and,or emotional abuse, chronic early maltreatment in a care-giing relationship, domestic
iolence, torture ciil war,. Some o the core characteristics o Complex P1SD are the loss o a
sense o saety, trust, and sel-worth, as well as the tendency to be ictimized, and, most impor-
tantly, the loss o a coherent sense o sel.
3%?)"A :M)77:8 Are behaioral tools used by indiiduals to deal with stressul situations. locus-
ing on coping skills may help a person ace a situation, take action, and be "exible in soling
problems. lor example one kind o coping skills are coping mechanisms, de!ned as the skills to
reduce stress, anger or interpersonal con"icts ,stress- and anger-management, con"ict-resolution
techniques,.
1/?/$:%"67)C6#)%"8 1he eeling that one is detached rom their body or the world. 1he person
will eel that they hae lost their sense o reality and will oten claim that lie eels like a moie,`
or that things seem unreal.
1/$/67)C6#)%"8 Is a state o dissociation ,See below,. lor some people it is an automatic reaction
in cases o external or internal stress. 1hey respond with a kind o tunnel ision ,See below,,
whereby they lose awareness o all elements o the eent that they normally perceie. People re-
port eeling like there is an inisible wall between them and the world, that they eel like they are
always day-dreaming, or that their ears and eyes don`t unction as well as beore.
1)::%()6#)%" ,See also: lragmenting, lreezing,: A perceied detachment o the mind rom the
emotional state or een rom the body. I someone dissociates, s,h get the eeling o being alien-
ated, and that the situation isn`t real. 1he threatening experience is split away rom the conscious-
ness.
1)::%()6#)0/ !&/"#)#; 1):%$&/$: A ery serious psychiatric disease, ormerly called Multiple
Personality Disorder.` A person who experiences multiple traumas can cause a person to dissoci-
ate completely, orming dierent personalities, each o which hae their own autonomous lie. A
person with this disorder does not een realize they are behaing like many dierent people.
1):#$/::: 1he bad` type o stress, which occurs when a person has excessie demands placed
on them. \hen the demands are too great, they can lead to physical and mental damage ,disease-
producing stress,.
B)A>#^B7)A># E/:?%":/: An automatic response to an experience that is perceied to be a lie
threat. 1he part o the brain that regulates autonomic and metabolic unctions prepares the
muscles to either !ght or "ee. A person experiencing repetitie traumatic experiences where there
is no opportunity to !ght or "ee can remain in a chronic state o physiological arousal, which is
ery stressul to the body.
B76:>56(M: R!"#$':)0/ E/(677S: An altered state o consciousness, during which the indiidual
beliees they are experiencing a traumatic eent all oer again. llashbacks are memories o past
Psychological Glossary Related to Trauma Issues
141
traumas. 1hey may take the orm o pictures, sounds, smells, body sensations, eelings or the
lack o them ,numbness,. llashbacks are sudden abreactions experienced oten by ictims o
trauma.
B$6A,/"#)"A ,See also: lreezing, Dissociation,: Just as reezing a kind o alienation rom a trau-
matic eent within the process o dissociation. It is a kind o protectie reaction to deal with a
terri!c situation, in which "ight or !ght is not possible. In the moment o the peak o traumatic
stress, the threatening experience will splinter into many pieces, which will be suppressed in such
a way, that the external eent can no longer be remembered cohesiely without a ery ocused e-
ort ,e.g. within therapy,. 1he bene!t o this strategy is, that through the remaining ragments or
splinters it is not any more perceptible what happened, only that something happened ,as well as
that we are not any more able to recognize a ace in the splinters o a broken mirror,. 1he rag-
ments are like little parts and single pictures o the trauma experience. 1hereore the suering
will be less painul.
B$//C)"A ,See also: lragmenting, Dissociation,: Just as ragmentation a psychological deense
mechanism within the process o dissociation to mentally escape rom ear and pain. It is a kind
o paralysis where the brain ,the rontal lobe is turned o, deends the person against threats by
internally dissociating rom the trauma. Lndogenic morphines helps to disappear mentally`.
<;?/$D0)A)76"(/: A symptom o P1SD where the person is oerly sensitie to sounds and sights,
scans their surroundings or expected danger, and eels edgy and nerous. A hyperigilant person
hae an exaggerated startle response.
!"#$':)0/ N>%'A>#:: Unwelcome, inoluntary thoughts, images, or unpleasant ideas that can
become obsessions, they are associated with depression or P1SD. 1hey are upsetting and can be
hard to manage and eliminate because they are persistent, paralyzing and anxiety-producing.
Q%:#DN$6',6#)( a$%G#>: \hen a person experiences positie lie change because o a trauma or
lie crisis. Although trauma is oten negatiely perceied, it also has positie aspects. Many people
who hae oercome trauma moe on to be inspirational !gures. 1his growth inoles a change in
sel-esteem, relationships with others, and proound spiritual or philosophical changes.
Q%:#DN$6',6#)( 4#$/:: 1):%$&/$: An anxiety disorder concerning a person`s response to trauma.
1he DSM-IV lists these criteria as required or P1SD: ,1, 1he person has experienced trauma
inoling an actual or perceied threat o death or serious bodily injury to onesel or others, and
their response was intense ear, helplessness, or horror, ,2, 1he trauma is re-experienced in cer-
tain ways, such as recurrent and intrusie memories or dreams, ,3, Persistent aoidance o stimuli
associated with the trauma, or general unresponsieness, ,4, Persistent symptoms o increased
arousal, like hyper-igilance or irritability, ,5, 1he disturbance lasts longer than one month, ,6,
1he disturbance causes clinically signi!cant distress or impaired unctioning.
41

E/:)7)/"(/: 1he ability to recoer rom ,or to resist being aected by, some shock, disturbance
or trauma.
4#6$#7/ $/:?%":/: 1raumatized people tend to be more easily startled by normal` enironmental
stimuli ,e.g. loud oices, bangs, sudden ast moements,.
N$6',6: 1he medical term reers to a wound or injury, but the psychological term reers to an
emotionally painul, distressul, or shocking experience, oten resulting in lasting mental or physi-
cal eects.
41
DSM-IV, Diagnostic and Statistical Manual o Mental Disorders, 4th Ldition, published by the American
Psychiatric Association, USA ,2000,.
142
People who experienced terri!c situations during many years and who hae oercome trauma moed on to be
inspirational !gures and role models: 1hey become powerul human right actiists, peaceul leaders in ciil soci-
ety, compassionate grandmothers, engaged dancing teachers at orphanages, writers, musicians etc.
Post-traumatic
growth
N$6',6#)( 1$/6,:: Particularly intense dreams that disturb the sleeper, either because o illness
or high eer, or psychological trauma or stress.
N$)AA/$: An eent, object or person that sets a series o thoughts in motion or reminds a person
o their traumatic past.
N'""/7 W):)%": \hen a person loses peripheral ision but retains central ision, resulting in a
constricted iew. It can be caused by eye disease, alcohol consumption, or stressul and traumatic
situations.
143
RLS ~ ,Aailable in Cambodia
Boyden, J., Gibbs, S. ,109,: Children o war. Responses to psycho-social distress in Cambodia,
Switzerland: UNRISD.
Danieli \, ed. ,1998,: International landbook o Multigenerational Legacies o 1rauma, New
\ork: Plenum Press.
lerman, J. ,1992,: 1rauma and Recoery, New \ork: Basic Books
Lareniere, B. ,2003,: Musik through the Dark. A tale o surial in Cambodia, Chiang Mai: Silk-
worm RLS
Linton, S. ,2004,: Reconciliation in Cambodia, Phnom Penh: DC-CAM RLS
Loung Ung ,2005,: Lucky Child. A daughter o Cambodia reunites with her sister she let behind,
New \ork: larper. RLS
Seanglim B. ,1991,: 1he \arrior leritage. A Psychological Perspectie o Cambodian 1rauma,
Caliornia. RLS
Seng, C.1heary ,2005,: Daughter o the killing !elds. Asrei`s story, London: lusion RLS
1edeschi, RG and Calhoun, L.G.: ,1995, 1rauma and 1ransormation: Growing in the
atermath o suering, New \ork: Sage.
1ranspersonal Psychosocial Organization ,1PO,, Cambodia ,199,: Community Mental lealth
in Cambodia, Phnom Penh. RLS
Van der Kolk, B.A. et al. ,1996,: 1raumatic stress, New \ork: Guilord.
\e beliee in a ife av Deretovevt approach. In other words,
Cambodians at all stages o lie can become more consciously
aware and learn to help one another to integrate their traumatic
past.
42
www.prayerguide.org.uk Last isited on 31 March 2008 1ranslation into Khmer by CSD
42
1he illustrator, SAM Sarath, at work
1he book is dedicated to our parents. laing experienced the traumas o war !rsthand either in
Germany or Cambodia, they hae taught us to deelop compassion or people who suer rom
atrocities and mental health issues.
Matthias \itzel, Author, Graphic Designer and Photographer
Psychologist and Psychotherapist, member o the German De-
elopment Serice ,DLD, and the Ciil Peace Serice ,ZlD,,
deliering the 1rauma Book to ormer Khmer Rouge soldiers in
Otdar Meanchey Proince.
OM Chariya, 1ranslator
An Lmotional Support Group member using the 1rauma Book
to help explain trauma and its eects to indigenous people in
Ratanakiri Proince.
\IM Sotheary, 1ranslator, Graphic Designer
\orking with the Lmotional Support Group` at CSD to intro-
duce the 1rauma Book in Ratanakiri Proince.
In one sense one could describe compassion as the eeling o unbearableness at the sight o other speople`s su-
ering, other sentient beings` suering. And in order to generate that eeling one must !rst hae an appreciation
o the seriousness or intensity o another`s suering.
So, I think that the more ully one understands suering, and the arious kinds o suering that we are subject to,
the deeper will be one`s leel o compassion.` Datai ava
46

Q$6;/$ B%$ Q/6(/
45
1he suering o Cambodia has been deep.
lrom this suering comes great compassion.
Great compassion makes a peaceul heart.
A peaceul heart makes a peaceul person.
A peaceul person makes a peaceul community.
A peaceul community makes a peaceul nation.
And a peaceul nation makes a peaceul world.
May all beings lie in happiness and peace.

Maba Cbo.avavaa
Peace I leae with you, my peace I gie you. I do not gie to you as the
world gies. Do not let your hearts be troubled and do not be araid.`
]e.v. Cbri.t ;]obv 11: 2)
45
www.buddhanetz.org,projekte,mahaghos.htm Last isited on 26 March 2008. 1ranslation into Khmer: CSD.
46
l.C.Cutler&ll Dalai Lama, 1he Art o lappiness. A landbook or Liing. London: lodder&Stoughton, p.94.
43
44

43
1he New 1estament in 1odays Khmer Version, United Bible Societies, Paris,long Kong 1993.
<%G ]%' 36" </7?
Our goal is to make this book aailable to all Cambodians. \hether you appreciate
its contents or are merely in a giing spirit, please make a !nancial contribution to-
wards haing this book reprinted. Lach book costs approximately USD to print.
I you or your organization would like to play a more prominent role in alleiating
trauma in Cambodia, an entire edition o 1000 or more books will be published
acknowledging your contribution either by name and,or logo.