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Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia

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Abstract

Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions. While the notion of idioms of distress is intended to draw attention to everyday non-pathologizing forms of discourse, the creation of hybrid assessment and treatment constructs linking idioms to trauma-related pathology may obscure the pragmatic communicative functions of the idiom, making them subordinate to an existing model of psychiatric disorder and pathologizing everyday modes of coping. Participants’ narratives highlight self-perceived connections between stressors that determine the trajectory and outcome of distress and shared cultural worldviews that together uniquely shape their meaning. These observations point to the dilemmas of linking idioms of distress with co-morbid illness constructs in ways that may pathologize normal emotional responses. Results have implications for efforts to develop effective models of post-conflict trauma care in global mental health.

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Notes

  1. Traditionally, neither familial private nor collective national commemorative stupas in Cambodia contain/display the skeletal remains of the dead. Liberation of the soul at death is considered according to Buddhist theology dependent upon cremation. The only exception is the temporary containment of skeletal relics of martyrized monks whose spiritual power can withstand the cosmological danger of delaying cremation. As of 1981, Genocide commemorative stupas are the only stupas that deviate from the above Buddhist tradition, displaying skeletal remains. Interviews with Cambodian museum CEOs and NGO CEOs who construct and fund the establishment of these collective sites of memory explain that both the first Vietnamese designer of these monuments and later Cambodian NGO workers copying this first model chose to deviate from Buddhist theology and practice intending to represent authentic material evidence and promote global and local genocide prevention.

  2. It is important to note that the high rate of accounts referring to political violence may reflect the recent mass exposure to genocide.

  3. None of the interlocutors in this study used the hybrid construct baksbat-trauma. This is only a clinical construct emergent from TPO's work. However, in contrast to previous fieldtrips (2011–2015), young NGO workers are now beginning to use the word “trauma” as translation of “baksbat.” In interviews with young interlocutors who have not yet been exposed to trauma discourse, they were often surprised by the researcher’s use of “baksbat” and they claimed to have rarely heard the word, and if at all only when describing the fearful and submissive older generation. When asked to provide a definition of the Khmer word baksbat, they described it as an emotion (as compared to and distinct from a sickness or chumeneu) most similar to fear.

  4. See Agger (2015) for an ethnographic study of the way Buddhist meditation and mindfulness techniques are used in traditional and contemporary hybrid rituals as healing methods to ease emotional distress. In keeping with the findings of the present study, Agger calls for the cultural contextualization of Khmer psycho-social distress within complex networks of spiritual meaning systems.

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Funding

Carol A. Kidron declares he/she has received funding from the Israel Science Foundation (Grant # 1611/15).

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Authors and Affiliations

  1. Department of Anthropology, University of Haifa, Mt. Carmel, Haifa, Israel

    Carol A. Kidron

  2. Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada

    Laurence J. Kirmayer

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  1. Carol A. Kidron
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  2. Laurence J. Kirmayer
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Correspondence to Carol A. Kidron.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kidron, C.A., Kirmayer, L.J. Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. Cult Med Psychiatry 43, 211–235 (2019). https://doi.org/10.1007/s11013-018-9612-9

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