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Finding mental health somewhere between east and west
To find the Unify Event Center in San Jose, you have to weave your way through a huge parking lot, swing around the Wal Mart, and follow the music into a large banquet hall. Today just happens to be Khmer or Cambodian New Year. There are about a hundred people in the hall, sitting around large circular tables while the house band warms up for the evening’s party.
It’s a small crowd, but this is a small community. An estimated 12,000 Cambodians live in the Bay Area. Khmer New Year is a positive reminder of their roots and homeland, despite the fact that so many came here under such traumatic circumstances.
In the early 1970s, Cambodia was in the middle of a brutal civil war. Eventually, the communist Khmer Rouge, led by Pol Pot, seized power. And its reign was characterized by horrifying sites of massacre known today as the “killing fields.” Nearly two million people died in the killing fields – a quarter of the country’s population in just four years.
“I don’t have any siblings right now,” says Khmer Rouge survivor and San Jose resident Sophany Bay. “I don’t have any brother, sister, I don’t have any nephew, any nieces, no nothing. They killed the whole family.”
In April 1975, Bay was living alone with her three small children in Phnom Penh. That’s when Khmer soldiers entered the city. She remembers the morning when the evacuation began: “We don't know where we are going. Where are we going you know? They just say, ‘Go, go, go,’ but we don't know. They use a gun, 'Go, go, go!’”
Over the course of many grueling months, Bay would watch each of her children die of malnutrition and disease as she worked in the concentration camps. She thinks about them every day, and dreams about the terror at night.
“I have nightmare, I have bad dream,” Bay sighs. “I never dream about my life in the United States. Always dream back to Pol Pot Regime."
Suffering from nightmares and sleep disorders is a common trait of PTSD, according to Stanford University psychiatrist Daryn Reicherter. Reicherter works with victims of political violence and serves as the psychiatrist for the Cambodian program at Gardner Mental Health clinic in San Jose. He’s been at Gardner for about eight years, but things were different when he began.
“The psychiatrist’s major function in this clinic when I joined it – it was simply to write prescriptions for antidepressants and sometimes antipsychotics,” Reicherter explains.
Nevertheless, at the time the Cambodian program was groundbreaking: there were Cambodian case managers and clinicians who spoke Khmer and guided group therapy sessions. Bay was one of the counselors, and she says her background really helped others open up, “I trust them, they trust me also. When they complain about nightmare, I believe because I have nightmare also.”
Many of Gardner’s Cambodian patients don’t speak English, according to Bophal Phen, another case manager at the clinic. And there are more difficulties than just the language barrier when dealing with the community, he says.
“They don’t read, they don’t write, so there’s a lot of paperwork they need to fill out before you can see a doctor,” Phen explains.
Over 90 percent of Cambodian Americans speak a language other than English in the home, and about half of Cambodians have less than a high school education. So it’s no surprise that the median income for Cambodian families is among the lowest of the Asian sub-groups, at just over $35,000 a year. It’s for those reasons, Phen says, that his clients have had trouble paying for and learning American systems, from insurance to public transportation. In fact, Gardner orders taxis to pick up and drop off most of its Cambodian patients because they don’t drive. Additionally, Gardner Mental Health provides help navigating social security, insurance, and legal issues. Phen himself makes house calls, along with Bay, but he says they’re still dealing with a serious culture gap.
“In Cambodia, we don’t have a lot of terminology for mental health. It’s a new field to us because of the war. During the killing fields, all scientific research or information was destroyed. I mean there was no such thing. Books were burned during the killing fields, so nothing was left.”
But as much as the Cambodian population in America wasn’t understanding psychiatry, western psychiatry wasn’t understanding Cambodians. Reicherter says that when he began at Gardner, 80-90% of his medication clients were on antipsychotic medications. "Medications used to treat disorders like schizophrenia," Reicherter explains, "when they did not have schizophrenia or anything like it."
According to Reicherter, previous psychiatrists were confused when Cambodian patients would come in and complain about a “ghost sitting on their chests.” Sophany Bay has experienced it. “Heavy! Too heavy! You know! Sit on my chest, I cannot wake up. I try to wake up but I cannot!” she describes.
Reicherter says that psychiatrists who hear that complaint have lots of questions: Is this person psychotic? Does this person have unusual beliefs about hauntings? Or is this person having serious nightmares wherein that’s the experience of the nightmare?
But for Cambodian patients, a "ghost sitting on your chest” is the best way to describe what they’re feeling; in fact, in Khmer there’s a name for it:khmaoch sângkât. Reicherter says the best translation is sleep paralysis with hypnogogic hallucination, when the motor system shutting down during dream sleep, leaving you temporarily paralyzed. But simply understanding this sleep phenomenon doesn’t necessarily move the conversation forward.
“If you explain that back to a Cambodian person, even our case managers, if you say well, ‘No, no, you’re not being visited by a ghost, what’s really happening with you is this appreciated, understood western phenomena that we call sleep paralysis' – they don’t accept that at all,” says Reicherter. “They’ll say, ‘No, I’m being visited by a ghost at night.’ Almost like: You’re not listening to me, you’re not hearing what I’m saying.”
After many of these kinds of conversations, the clinic decided to bring in a different kind of expert: a Buddhist monk.
“The monk has established their role as a healer. We, mental health counselor, have not established that role yet in our community,” explains Phen.
It started when Reicherter was visiting Cambodia a few years ago, observing how mental health groups were caring for survivors there. He found that providers addressed mental health needs in spiritual terms, and that temples were working in concert with the caregivers. So at Gardner, the Cambodian Program now invites monks to lead meditation sessions in the clinic, with the help of one of the Cambodian counselors. The program aims to bridge the gap between western psychiatry and eastern spirituality.
On a recent morning, Bay is leading the meditation – she’s filling in for the monk who usually leads the session. There are about five or six people sitting on the floor while Bay reviews lessons from previous sessions: don’t steal, don’t kill. And then the meditation session begins. For the next half hour or so, everyone sits quietly in a circle. One person falls asleep. Bay says that’s okay – the point is to get people out of their house and better connected with mental health services, if they're open to it.
“Life is a struggle. You have to struggle to live in the United States,” Bay says.
These sessions have happened every week for about three years now, and when asked whether they’ve been effective, Reicherter hesitates before he gives a firm answer. He explains that the studies they’ve done have demonstrated unrealistically good numbers, “You know, basically in many people, complete remission. Which I…I’m pretty certain is inaccurate.”
Reicherter says that the likelihood of a complete turnaround for this community in just a couple years is low – really low. Their surveys have improved, but Reicherter and his colleagues are still figuring out the right questions to ask.
Still, the Cambodian program looks to be going in a good direction. There are now over 90 clients and five Cambodian-speaking staff. And Reicherter says that’s important for everyone in the Bay Area, not just Cambodians: “The Cambodian population in San Jose is a very marginalized and very complicated population. And this is our American community.”
Back at the Unify Event Center in San Jose, you can almost see two different experiences of the celebration. The younger generation was born here, far from what their parents suffered under the Pol Pot regime. They’re here to dance and connect with neighborhood friends. But for their parents, this is an important day to remember where they came from. It’s a part of their home that they’re still happy to have with them.
Erica Mu has been reporting on Asian American mental health as part ofThe California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication & Journalism.
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Health, Science, Environment
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