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Culture, Medicine, and Psychiatry

, Volume 43, Issue 2, pp 211–235 | Cite as

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

  • Carol A. KidronEmail author
  • Laurence J. Kirmayer
Original Paper

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.

Keywords

Trauma Idioms of distress Cultural competence Cambodia Khmer Global mental health 

Notes

Funding

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

Compliance with Ethnical Standards

Conflict of interest

The authors declare they have no conflicts of interest.

Research Involving Human Participants and/or Animals

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.

Informed Consent

Informed Consent was obtained from all individual participants involved in the study.

References

  1. Abramowitz, Sharon Alane 2010 Trauma and Humanitarian Translation in Liberia: The Tale of Open Mole. Culture, Medicine, and Psychiatry 34(2): 353-379.Google Scholar
  2. Agger, Inger 2015 Calming the mind: Healing after mass atrocity in Cambodia. Transcultural Psychiatry 52(4): 543-560.Google Scholar
  3. Agger, Inger, Victor Igreja, Rachel Kiehle, and Peter Polatin 2012 Testimony ceremonies in Asia: Integrating spirituality in testimonial therapy for torture survivors in India, Sri Lanka, Cambodia, and the Philippines. Transcultural Psychiatry 49(3-4): 568-589.Google Scholar
  4. American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders (5th edition). Arlington, VA: American Psychiatric Publishing.Google Scholar
  5. Argenti-Pillen, Alex 2000 The discourse on trauma in non-Western cultural contexts: contributions of an ethnographic method. In: International handbook of human response to trauma. Arieh Y. Shalev, Rachel Yehuda, and Alexander C. McFarlane, eds., pp. 87–102. New York: Kluwer.Google Scholar
  6. Bonanno, George A. 2004 Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?. American Psychologist 59(1): 20-28.Google Scholar
  7. Chhim, Sotheara 2012 Baksbat (Broken Courage): The Development and Validation of the Inventory to Measure Baksbat, a Cambodian Trauma-based Cultural Syndrome of Distress. Culture, Medicine, and Psychiatry 36(4): 640-659.Google Scholar
  8. Chhim, Sotheara 2013 Baksbat (Broken Courage): A Trauma-Based Cultural Syndrome in Cambodia. Medical Anthropology 32(2): 160-173.Google Scholar
  9. Davis, Erik W. 2016 Deathpower: Buddhism’s ritual imagination in Cambodia. New York: Columbia University Press.Google Scholar
  10. Denzin, Norman K. 1970 The research act in sociology: A theoretical introduction to sociological method. Chicago: AldineTransaction Publishing.Google Scholar
  11. Eggerman, Mark, and Catherine Panter-Brick 2010 Suffering, hope, and entrapment: Resilience and cultural values in Afghanistan. Social Science & Medicine 71(1): 71-83.Google Scholar
  12. Farmer, Paul 1999 Pathologies of Power: Rethinking Health and Human Rights. American Journal of Public Health 89(10): 1486-1496.Google Scholar
  13. Frye, Barbara A. and Carolyn D. D’Avanzo 1994 Cultural Themes in Family Stress and Violence among Cambodian Refugee Women in the Inner City. Advances in Nursing Science 16(3): 64-77.Google Scholar
  14. Gone, Joseph P. 2013 Redressing First Nations Historical Trauma: Theorizing Mechanisms for Indigenous Culture as Mental Health Treatment. Transcultural Psychiatry 50 (5): 683-706.Google Scholar
  15. Herring, Susan C. (2010) Web content analysis: Expanding the Paradigm. In: Jeremy Hunsinger, Lisbeth Klastrup, and Matthew M. Allen (eds.) International Handbook of Internet Research, pp. 233-249. Houten: Springer.Google Scholar
  16. Hinton, Alex L. 2004 Why did they kill?: Cambodians in the shadow of genocide. Berkeley: University of California Press.Google Scholar
  17. Hinton, Alex L. 2009 DC-Cam’s Victims of Torture Project: An Evaluation. Retrieved June 11, 2018, from http://www.d.dccam.org/Projects/VOT/Evaluation_of_VOT_Project_by_Alex_Hinton.pdf.
  18. Hinton, Devon E. and Naomi M. Simon 2015 Toward a cultural neuroscience of anxiety disorders. In: Re-visioning psychiatry: Cultural phenomenology, critical neuroscience, and global mental health. Laurence J. Kirmayer, Robert Lemelson, & Constance A. Cummings, eds., pp. 343-374. New York: Cambridge University Press.Google Scholar
  19. Hinton, Devon. E. and Byron J. Good 2015 Culture and PTSD: Trauma in global and Historical Perspective. University of Pennsylvania Press, Philadelphia.Google Scholar
  20. Hinton, Devon E., Ria Reis, and Joop de Jong 2015 The “Thinking a Lot” Idiom of Distress and PTSD: An Examination of Their Relationship among Traumatized Cambodian Refugees Using the “Thinking a Lot” Questionnaire. Medical Anthropology Quarterly 29(3): 357-380.Google Scholar
  21. Kaiser, Bonnie N., Emily E. Haroz, Brandon A. Kohrt, Paul A. Bolton, Judith K. Bass, and Devon E. Hinton 2015 “Thinking too much”: A systematic review of a common idiom of distress. Social Science & Medicine 147: 170-183.Google Scholar
  22. Kidron, Carol A. 2012 Alterity and the Particular Limits of Universalism: Comparing Jewish-Israeli Holocaust and Canadian-Cambodian Genocide Legacies. Current Anthropology 53(6): 723-754.Google Scholar
  23. Kidron, Carol A. 2015 Global Humanitarian Interventions: Managing Uncertain Trajectories of Cambodian Mental Health. In Modes of Uncertainty: Anthropological Cases. P. Rabinow and L. Samimian Darash, eds., pp. 105-120. Chicago University Press.Google Scholar
  24. Kidron, Carol A. 2018 Resurrecting Discontinued Bonds: A Comparative Study of Israeli Holocaust and Cambodian Genocide Trauma Descendant Relations with the Genocide Dead. Ethos 46(2): 230-253.Google Scholar
  25. Kirmayer, Laurence J. 2015a Re-Visioning Psychiatry: Toward an Ecology of Mind in Health and Illness. In Re-Visioning Psychiatry: Cultural Phenomenology, Critical Neuroscience and Global Mental Health. L. J. Kirmayer, R. Lemelson, and C. A. Cummings, eds., pp. 622-660. New York: Cambridge University Press.Google Scholar
  26. Kirmayer, Laurence J. 2015b Wrestling with the Angels of History: Memory, Symptom, and Intervention. In Genocide and Mass Violence: Memory, Symptom, and Recovery. D. E. Hinton and A. L. Hinton, eds, pp.388-420. New York: Cambridge University Press.Google Scholar
  27. Kirmayer, Laurence J. and Duncan Pedersen 2014 Towards a New Architecture for Global Mental Health. Transcultural Psychiatry 51(6):759-776.Google Scholar
  28. Kirmayer, Laurence J., Gomez-Carrillo, A., and Veissiere, Samuel. 2017 Culture and Depression in Global Mental Health: An Ecosocial Approach to the Phenomenology of Psychiatric Disorders. Social Science & Medicine 183: 163-168.Google Scholar
  29. Kellerman, Natan P. F. 2001 Psychopathology in children of Holocaust survivors: A review of the research literature. Israel Journal of Psychiatry and Related Sciences 38(1): 36-46.Google Scholar
  30. Kohrt, Brandon A., and Daniel J. Hruschka 2010 Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma. Culture, Medicine, and Psychiatry 34(2): 322-352.Google Scholar
  31. Ledgerwood, Judy 2012 Buddhist Ritual and the Reordering of Social Relations in Cambodia. Southeast Asia Research 20(2): 191-205.Google Scholar
  32. Manor-Binyamini, Iris and Avihu Shoshana 2018 Listening to Bedouin Mothers of Children with Autism. Culture, Medicine and Psychiatry 42(2): 401-418.Google Scholar
  33. Nichter, Mark 1981 Idioms of distress: Alternatives in the expression of psychosocial distress: A case study from South India. Culture, Medicine and Psychiatry 5(4): 379-408.Google Scholar
  34. Nichter, Mark 2010 Idioms of Distress Revisited. Culture, Medicine, and Psychiatry 34(2): 401-416.Google Scholar
  35. Noy, Chaim 2008 Sampling Knowledge: The Hermeneutics of Snowball Sampling in Qualitative Research. International Journal of Social Research Methodology 11(4): 327-344.Google Scholar
  36. Panter Brick, Catherine 2014 Health Risk and Resilience: Interdisciplinary Concepts and Applications. Annual Review of Anthropology 43: 431-448.Google Scholar
  37. Pederson, Duncan, Hanna Kienzler and Jaswant Guzder 2015 Search for the Best Practices: A Systematic Inquiry into the Nature of Psychosocial Interventions Aimed at Reducing the Mental Health Burden in Conflict and Post-Conflict Settings. Sage OPEN, Thousand Oaks 1-25.Google Scholar
  38. Pillen, Alex 2016 Language, Translation, Trauma. Annual Review of Anthropology 45:95-111.Google Scholar
  39. Sagi-Schwartz, Abraham, Marinus H. Jzendoorn, Klaus E. Grossmann, Tirtsa Joels, Karin Grossmann, Miri Scharf, Nina Koren-Karie, and Sarit Alkalay 2003 Attachment and Traumatic Stress in Female Holocaust Child Survivors and Their Daughters. American Journal of Psychiatry 160(6): 1086-1092.Google Scholar
  40. Scharf, Miri 2007 Long-term effects of trauma: Psychosocial functioning of the second and third generation of Holocaust survivors. Development and Psychopathology 19(02): 603-622.Google Scholar
  41. Sonis, Jeffrey, James L. Gibson, Joop T. V. M. de Jong, Nigel P. Field, Sokhom Hean, and Ivan Komproe 2009 Probable Posttraumatic Stress Disorder and Disability in Cambodia: Associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. JAMA 302(5): 527-536.Google Scholar
  42. Summerfield, Derek 1999. A Critique of Seven Assumptions behind Psychological Trauma Programmes in War Afflicted Areas. Social Science & Medicine 48(10): 1449-1462.Google Scholar
  43. Thompson, Ashley 2006 Buddhism in Cambodia: Rupture and continuity. In: Buddhism in world cultures: Comparative perspectives. Stephan C. Berkwitz, ed., pp. 129-169. Santa Barbara, CA: ABC-CLIO.Google Scholar
  44. TPO Cambodia 2015 The Need for Mental Health Care in Cambodia. TPO Cambodia. Retrieved April 23, 2018, from http://tpocambodia.org/the-need/.
  45. Un, Kheang 2005. Patronage Politics and Hybrid Democracy: Political Change in Cambodia, 1993-2003. Asian Perspective 29(2): 203-230.Google Scholar
  46. Young, Allan 1995 Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.Google Scholar
  47. Allan Young, Naomi Breslau (2015) What is PTSD?: The Heterogeneity Thesis. In: Devon E. Hinton and Byron J. Good (eds.) B Culture and PTSD: Trauma in Global and Historical Perspective, pp. 135-154. University of Pennsylvania Press, Philadelphia.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of HaifaHaifaIsrael
  2. 2.Division of Social and Transcultural PsychiatryMcGill UniversityMontrealCanada

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