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


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.


Trauma Idioms of distress Cultural competence Cambodia Khmer Global mental health 



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.


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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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