Abstract
Ghost encounters were found to be a key part of the trauma ontology among Cambodian refugees at a psychiatric clinic, a key idiom of distress. Fifty-four percent of patients had been bothered by ghost encounters in the last month. The severity of being bothered by ghosts in the last month was highly correlated to PTSD severity (r = .8), and among patients bothered by ghosts in the last month, 85.2% had PTSD, versus among those not so bothered, 15.4%, odds ratio of 31.8 (95% confidence level 11.3–89.3), Chi square = 55.0, p < .001. Ghost visitations occurred in multiple experiential modalities that could be classified into three states of consciousness: full sleep (viz., in dream), hypnagogia, that is, upon falling asleep or awakening (viz., in sleep paralysis [SP] and in non-SP hallucinations), and full waking (viz., in hallucinations, visual aura, somatic sensations [chills or goosebumps], and leg cramps). These ghost visitations gave rise to multiple concerns—for example, of being frightened to death or of having the soul called away—as part of an elaborate cosmology. Several heuristic models are presented including a biocultural model of the interaction of trauma and ghost visitation. An extended case illustrates the article’s findings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Of note, there are other major categories of spirits, like preta (Davis 2016), but these were not mentioned by patients as being the ghost visitors that they encountered.
That is, the person is partially awake but unlike in SP can move.
A beuysaach may appear having just one of these characteristics like wide eyes in order to fool the living, for example, when trying to lure someone in a dream.
Also, the word prieuy highly resembles the reduplicative that describes flashing, prieuk prieuk, a reduplicative that Cambodian patients often use to depict the flashing of a visual aura; through the sound symbolism of this initial consonant-and-vowel cluster, this reduplicative creates a sense of explosive emission.
We previously put forth models for visual aura, sleep paralysis, and nightmare, but here we present a more general biocultural model of ghost visitation among trauma survivors.
As will be discussed below, Cambodians have a greatly feared type of ghost visitation in which the person is called or summoned.
The term “hypnagogic” refers to the period at sleep onset and “hypnopompic” to the period of awakening. As others have done (Waters et al. 2016), we will refer to the hypnagogic and hypnopompic states as “hypnagogia.”
In sleep paralysis, hallucinations other than visual ones may occur such as olfactory or auditory but by far the most common hallucination is a visual hallucination of a descending form.
Among Cambodian patients, the hypnagogia hallucinations that occur in SP tend to differ from other hypnagogia hallucinations. SP hallucinations usually consist of seeing a shadow descending from above down upon the supine body, with a sense of chest oppression as the shadow descends. By way of contrast, non-SP hypnagogia hallucinations are not uncommonly sounds, and when non-SP hypnagogia visual hallucinations occur, what is seen is usually a figure that stands by the bed or moves in or out of the room, without there being a sense of pressure on the chest.
The person may attribute the actual experiencing of the senses, such as hearing the steps of someone walking in the house or smelling actual ambient smells, to a ghost attack. But these seemed to be unusual events in those surveyed. The hallucinations seemed to be internally generated; this is clearly the case in such events as hearing oneself being summoned.
Inside of the scintillating scotoma there is often a shadow that is not uncommonly considered to be a floating ghost.
These shadows are often part of a scintillating scotoma (Hinton et al. 2018).
Often the person may then suspect the presence of a ghost and scan the environment for a ghost and perceive a shadow cutting by.
We use here the term “ghost” to translate the Cambodian term “khmaoch.” But khmaoch can mean either a corpse or the form a person’s spirit takes after death, that is, what is usually referred to in English as a “ghost,” so the term “khmaoch” might most accurately be translated as “corpse/ghost” to best depict its referents. These might be called the word’s “dynamic interpretants” as defined by Peirce (Misak 2004): the term “khmaoch” may bring to mind viewed corpses as well as ghostly presence. The word khmaoch has sound symbolism that creates a sense of assault: the initial consonant cluster is guttural and the word’s end is a sudden stop. (In Khmer, the terminal “ch” is a complete stop with no following vowel sound, unlike in English.) In addition, the word khmao means “black” in Cambodian, suggesting inauspiciousness.
Often patient with ghost attacks will be told by monks that their minds and bodies are weak from “thinking too much,” and will be told to put their mind on good things. A harried mind is said to have a floating quality—mirrored by the floating nature of the attentional spotlight—and to be susceptible to ghost attack. Meditation may be suggested as a means to help the mind to focus.
Patients with ghost attacks commonly go the temple to request the monk to do a protective ritual in which the monk ties a protective holy string at the wrist. The monks may look at the patient’s spiritual state, determining which of twelve symbols represents the patient’s spiritual level; in the worst case scenario, the patient will be told he or she has the low spiritual energy referred to as “bad luck cuts the neck” (krueh kat kâ), represented by a headless body. Often patients appear in clinic with several strings encircling the wrists, protective bracelets. Sometimes a section of string from a special ceremony to make a temple holy will be used to make a protective bracelet, a ceremony in which a protective perimeter around the temple is formed. These rites aim to create a sense of protective encircling powers, creating what might be called concentric ontological security.
Shadows were also commonly seen: in dream, in hallucination (viz., hallucination in sleep paralysis; in non-SP hypnagogia; and in full waking), and in the form of the dark part of the scintillating scotoma. A patient might attribute all these attacks to the same ghost.
Studies have shown high rates of hallucination and the experience of spirit visitation in depression in Latino populations (Cassano et al. 2012).
Of note, this model should be applied to the cross-cultural study of ghost visitation that involves possession. (Possession was not an issue in those surveyed in this study.) Future studies need to investigate if this model applies, in particular assessing in detail the states of consciousness of occurrence such as a dissociative state (de Jong and Reis 2013; Seligman and Brown 2010). The current model can be used to investigate such issues and to further the study of possession and mass possession (Eisenbruch 2017; Reis 2016; Seligman and Brown 2010).
References
Arensen, L. 2017 The Dead in the Land: Encounters with Bodies, Bones, and Ghosts in Northwestern Cambodia. The Journal of Asian Studies 76:69-86.
Cassaniti, J. L., and T. M. Luhrmann 2014 The Cultural Kindling of Spiritual Experiences. Current Anthropology 55:S333-S343.
Cassano, P., M. Fava, and D. Mischoulon 2012 Major Depressive Disorder with Psychosis-Like Symptoms among Latinos. Psychiatric Services 63(5):482-7.
Davis, E. 2016 Deathpower: Buddhism’s Ritual Imagination in Cambodia. New York: Columbia University Press.
de Jong, J. T., and R. Reis 2010 Kiyang-Yang, a West-African Postwar Idiom of Distress. Culture, Medicine, and Psychiatry 34:301–321.
de Jong, J. T., and R. Reis 2013 Collective Trauma Resolution: Dissociation as a Way of Processing Post-War Traumatic Stress in Guinea Bissau. Transcultural Psychiatry 50:644-661.
de Leede-Smith, S., and E. Barkus 2013 A Comprehensive Review of Auditory Verbal Hallucinations: Lifetime Prevalence, Correlates and Mechanisms in Healthy and Clinical Individuals. Frontiers Human Neuroscience 7:367.
Eisenbruch, M. 2017 Mass Fainting in Garment Factories in Cambodia. Transcultural Psychiatry 54(2):155-178.
Eisenbruch, M. 2019 Putting the Spirit into Culturally Responsive Public Health: Explaining Mass Fainting in Cambodia. Journal of Religious Health 58(1):317-332.
Gibson, L. E., L. B. Alloy, and L. M. Ellman 2016 Trauma and the Psychosis Spectrum: A Review of Symptom Specificity and Explanatory Mechanisms. Clinical Psychology Review 49:92-105.
Gregor, K. L., M. J. Zvolensky, and A. R. Yartz 2005 Perceived Health among Individuals with Panic Disorder: Associations with Affective Vulnerability and Psychiatric Disability. Journal of Nervous and Mental Disease 193(10):697-9.
Guillou, A. Y. 2012 An Alternative Memory of the Khmer Rouge Genocide: The Dead of the Mass Graves and the Guardian Spirits [Neak Ta]. South East Asia Research 20:207-226.
Gustafsson, Mai Lan 2009 War and Shadows: The Haunting of Vietnam. Ithaca: Cornell University Press.
Hammen, C. 2015 Stress Sensitivity in Psychopathology: Mechanisms and Consequences. J ournal of Abnormal Psychology 124(1):152-4.
Hamner, M. B., B. C. Frueh, H. G. Ulmer, M. G. Huber, T. J. Twomey, C. Tyson, and G. W. Arana 2000 Psychotic Features in Chronic Posttraumatic Stress Disorder and Schizophrenia: Comparative Severity. Journal of Nervours Mental Disease 188(4):217-21.
Harkness, K. L., E. P. Hayden, and N. L. Lopez-Duran 2015 Stress Sensitivity and Stress Sensitization in Psychopathology: An Introduction to the Special Section. Journal of Abnormal Psychology 124(1):1-3.
Hinton, D. E., and B. J. Good, eds.2016 Culture and PTSD: Trauma in Historical and Global Perspective. Pennsylvenia: University of Pennsylvenia Press.
Hinton, D.E., A. Hinton, D. Chhean, V. Pich, J.R. Loeum, and M.H. Pollack 2009aNightmares among Cambodian Refugees: The Breaching of Concentric Ontological Security. Culture, Medicine, and Psychiatry 33:219–265.
Hinton, D. E., S. Peou, S. Joshi, A. Nickerson, and N. Simon 2013Normal Grief and Complicated Bereavement among Traumatized Cambodian Refugees: Cultural Context and the Central Role of Dreams of the Deceased. Culture, Medicine, and Psychiatry 37:427–464.
Hinton, D. E., V. Pich, D. Chhean, and M. H. Pollack 2005 “The Ghost Pushes You Down”: Sleep Paralysis-Type Panic Attacks in a Khmer Refugee Population. Transcultural Psychiatry 42:46–78.
Hinton, D.E., A. Rasmussen, L. Nou, M.H. Pollack, and M.J. Good 2009b Anger, PTSD, and the Nuclear Family: A Study of Cambodian Refugees. Social Science and Medicine 69:1387–1394.
Hinton, D. E., R. Reis, and J. de Jong2018 Migraine-Like Visual Auras among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters. Culture, Medicine, and Psychiatry 42:244–277.
Hinton, D. E., and N. Simons 2015 Somatization, Anxiety Disorders (GAD, Panic Disorder, and PTSD), and the Arousal Complex in Cultural Context: The Multiplex Model and the Cultural Neuroscience of Anxiety Disorders. In Revisioning Psychiatry: Cultural Phenomenology, Critical Neuroscience, and Global Mental Health. L.J. Kirmayer, R. Lemelson, and C. Cummings, eds. pp. 343-374. Cambridge, U.K.: Cambridge University Press.
Hollan, D. 1995 To the Afterworld and Back: Mourning and Dreams of the Dead among the Toraja. Ethos 23:424–436.
Hollan, D. 2004 Self Systems, Cultural Idioms of Distress, and the Psycho-Biology Consequences of Childhood Suffering. Transcultural Psychiatry 41:62–79.
Hollan, D. 2014 From Ghosts to Ancestors (and Back Again): On the Cultural and Psychodynamic Mediation of Selfscapes. Ethos 42:175-197.
Igreja, V. 2003 Why Are There So Many Drums Playing until Dawn?’ Exploring the Role of Gamba Spirits and Healers in the Post-War Recovery Period in Gorongosa, Central Mozambique. Transcultural Psychiatry 40:459–487.
Igreja, V., W. Kleijn, and A. Richters 2006 When the War Was over, Little Changed: Women’s Posttraumatic Suffering after the War in Mozambique. Journal of Nervous and Mental Disease 194:502–509.
Kirmayer, L. J., and A. Gomez-Carrillo 2019 Agency, Embodiment and Enactment in Psychosomatic Theory and Practice. Medical Humanities 45(2):169-182.
Kwon, H. 2006 After the Massacre: Commemoration and Consolation in Ha My and My Lai. Berkeley: University of California.
Kwon, H. 2008 Ghosts of War in Vietnam. Cambridge: Cambridge University Press.
Kwon, H. 2014 The Vietnam War Traumas. In Genocide and Mass Violence: Memory, Symptom, and Recovery. D.E. Hinton and A.L. Hinton, eds. Cambridge: Cambridge University Press.
Luhrmann, T. M. 2013 Making God Real and Making God Good: Some Mechanisms through Which Prayer May Contribute to Healing. Transcultural Psychiatry 50:707-725.
McDonald, S. D., and P. S. Calhoun 2010 The Diagnostic Accuracy of the PTSD Checklist: A Critical Review. Clinical Psychology Review 30:976–987.
McGrath, J. J., S. Saha, C. C. W. Lim, S. Aguilar-Gaxiola, J. Alonso, L. H. Andrade, E. J. Bromet, R. Bruffaerts, J. M. Caldas de Almeida, G. Cardoso, G. de Girolamo, J. Fayyad, S. Florescu, O. Gureje, J. M. Haro, N. Kawakami, K. C. Koenen, V. Kovess-Masfety, S. Lee, J. P. Lepine, K. A. McLaughlin, M. E. Medina-Mora, F. Navarro-Mateu, A. Ojagbemi, J. Posada-Villa, N. Sampson, K. M. Scott, H. Tachimori, M. Ten Have, K. S. Kendler, R. C. Kessler, and W. H. O. World Mental Health Survey Collaborators 2017 Trauma and Psychotic Experiences: Transnational Data from the World Mental Health Survey. British Journal of Psychiatry 211(6): 373–380.
Misak, C.J. 2004 The Cambridge Companion to Peirce. Cambridge: Cambridge University Press.
Qingzhen, L., M. Jiehua, Y. Zhiyang, L. Hongjun, C. Chunlong, and L. Weiyan 2016 Distinct Hippocampal Expression Profiles of Lncrnas in Rats Exhibiting a PTSD-Like Syndrome. Molecular Neurobiology 53:2161-8.
Reis, R. 2016 Children’s Idioms of Distress. In The Routledge Handbook of Medical Anthropology. L. Manderson, ed. pp. 36–42. New York, NY: Routledge.
Seligman, R., and R. A. Brown 2010 Theory and Method at the Intersection of Anthropology and Cultural Neuroscience. Social Cognitive and Affective Neuroscience 5(2-3):130-137.
Soosay, I., D. Silove, C. Bateman-Steel, Z. Steel, P. Bebbington, P. B. Jones, T. Chey, L. Ivancic, and C. Marnane 2012 Trauma Exposure, PTSD and Psychotic-Like Symptoms in Post-Conflict Timor Leste: An Epidemiological Survey. BMC Psychiatry 12:229.
Waters, F., J. D. Blom, T. T. Dang-Vu, A. J. Cheyne, B. Alderson-Day, P. Woodruff, and D. Collerton 2016 What Is the Link between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences? Schizophrenia Bulletin 42(5):1098-109.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author has no conflict of interest.
Informed Consent
Informed consent was obtained from all participants, and the study was conducted as per 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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hinton, D.E., Reis, R. & de Jong, J. Ghost Encounters Among Traumatized Cambodian Refugees: Severity, Relationship to PTSD, and Phenomenology. Cult Med Psychiatry 44, 333–359 (2020). https://doi.org/10.1007/s11013-019-09661-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11013-019-09661-6