Deep-seated, unresolved trauma suffered by millions during the Khmer Rouge regime

is causing massive problems, and depression of parents is being transferred to their

children, say mental health experts.

Child laborers during the Pol Pot era.

In Phalla wipes away her tears with a red krama as she calculates how long she put

up with physical abuse. She says her husband began beating her soon after her third

child, a boy, was born. He is now 13. The ordeal seemed never ending, and culminated

in her husband dousing her with kerosene in an attempt to set her alight.

"I ran away from home because I couldn't take it any more. He beat me for 13

years. When I was in despair at my destiny I tried to kill myself," says Phalla,

who is still too scared to use her real name. "I was ready to hang myself in

the forest with my krama but my six children asked me not to. I changed my mind because

I felt so sorry for them."

There is a virtual absence of reliable statistics on suicide rates in Cambodia, but

mental health and women's issues experts say the two groups who are most likely to

attempt suicide are adolescents, and women like Phalla who have suffered trauma and

abuse.

Ministry of Interior (MoI) figures show that 198 people either committed suicide

or attempted suicide in 1999. That number increased to 253 the following year, before

dropping back to 193 in 2001.

However Chea Bunthol, administrative chief of the MoI's crime department, admits

the statistics are not accurate because police fail to fill out MoI suicide forms

and often don't investigate suspected suicides.

Mental health issues are depicted in this poster produced by the TPO organization.

"When the police conclude it is a suicide case, they just hand over the body

to the family and don't study what pushes people to commit suicide," he says.

"The [country's] leadership hasn't paid attention to this issue."

Dr J. Bhoomi Kumar, director of the Center for Child Mental Health at Chey Chumneas

Hospital in Kandal, believes that suicide is "grossly unreported" here

as in most Asian countries.

"This is because of cultural issues such as Cambodia's form of Buddhism which

looks down on suicide," he says. "Suicide is much more acceptable in Japan

and Vietnam."

The Ministry of Cult and Religion says that Buddhism, the country's major religion,

forbids suicide. Secretary of state Chhorn Eam believes suicide is wrong.

"As human beings we must be useful to society," he says. "We shouldn't

kill ourselves - we should find a way to live and contribute. To kill oneself is

cowardly. Life means struggle."

Suicides are reported almost daily in Khmer language newspapers, and several mental

health experts say they think this indicates that the number of attempts is increasing.

Across the world the figures are dramatic: the World Health Organization (WHO) estimates

that around one million people committed suicide in 2000. That equates to one death

every 40 seconds.

WHO's figures show that suicide rates have increased globally by 60 percent in the

last half century. Suicide attempts are even more common, running at 20 times the

number of suicides.

The increased reporting of suicide in Cambodia may be an indication of society's

increasing openness, with families now allowing the media to write about the deaths

of their relatives when previously the subject was taboo.

Dr Kek Galabru, the president of human rights NGO Licadho and a medical doctor, says

that until 1992 there was little discussion of the issue in the media.

"There were only five newspapers that were always controlled by [political]

parties, but now the press has more freedom," she says. "We cannot say

there are more suicides - it is just much more open now and people are willing to

let others know outside the family."

Despite uncertainty over whether the rate of suicide is increasing, Dr Kek, Dr Kumar

and other experts do agree that deep-seated, unresolved, trauma suffered by millions

during the Khmer Rouge regime is causing massive problems.

Dr Kumar says the trauma and depression of parents is transferred to their children.

"The current parents were in Pol Pot's children's groups, so they lack direct

parenting experience and lack knowledge in how to help, counsel and provide guidance,"

he says. Alcoholism has increased as some struggle to cope with their mental burden,

he adds, which has led to a rise in domestic violence.

Kann Kall is a mental health expert and former managing director of a local mental

health NGO called the Transcultural PsychoSocial Organization (TPO). He says psychological

and emotional distress is the major cause of suicide attempts.

Kall believes that most Cambodians aged below 25 have been living with stress projected

from their families their entire lives. The collective nature of Khmer society, he

says, means children are bound to their families and, unlike in Western societies,

are unable to escape transferred stress by leaving when they are young.

"Parents suffered directly from the civil war and the Khmer Rouge regime, and

the tension keeps on and on because these people never have a chance to feel relief,"

he says. "They project it onto the younger generation, so most of today's society

is a second trauma generation without knowing why."

Kall says that a culture of 'saving face' and hiding problems from outsiders to protect

a family's reputation compounds the problem of widespread stress as people feel unable

to express themselves and seek counseling.

"According to the women's code of conduct, women should behave well and not

speak out, but this kind of philosophy suppresses women," warns Kall. The result,

he says, is that women younger than 25 are the most likely to attempt suicide.

On the surface, many suicides reported in newspapers seem to be related to lost or

unrequited love. However Dr Kek says other issues such as the absence of parental

support, limited career opportunities, and poverty are often the real culprits. An

unhappy love affair simply acts as a trigger for suicides.

"It is a disease of our society," says Dr Kek. "The young should be

happy and not commit suicide. They should stay and fight, but the issues are so deep

and then [problems with] love tip them over the edge."

Poverty and lack of education are recognized by mental health experts as major factors

in suicide, and Cambodia is afflicted with both: it is one of the poorest countries

in Asia, with 36 percent of the population living under the poverty line of 50 cents

per day. The government estimates that little more than one-third of the population

is literate.

TPO's Kall says most people committing suicide in Cambodia have little education.

Along with psychological and emotional distress, he cites poverty and a lack of accessible

social support as the main reasons behind suicide.

"A lot of the social mechanisms don't work and police don't give hope when people

are abused," Kall says. "For the poor it is a cycle: many are forced to

leave home to work in a brothel or as slaves, and when they complain about abuses

to the police they are asked to pay fees and the police make trouble."

Women and children are hit particularly hard by this cycle. Experts in the fields

of women's issues and mental health identify domestic violence, human trafficking,

rape and forced prostitution as important factors.

Naly Pilorge, deputy director of Licadho, says her organization has received a number

of victims of domestic violence who want to commit suicide.

"We also have a few cases of women who are victims of other abuses, compounded

by other problems such as economic [worries]," she says.

Chanthol Oung, executive director of the Cambodian Women's Crisis Center, says five

women at her shelter have attempted suicide this year alone. They are most vulnerable

when they first arrive.

"We do have many cases of women who try to commit suicide because of domestic

violence," she says. "Also some women come because of depression, trafficking,

rape and forced prostitution."

Besides acknowledging that women and adolescents are most vulnerable to suicide,

experts say those in urban areas are more like to take their own lives. Dr Kumar

attributes this to the 'anonymity factor': people are more alienated and less likely

to know their neighbors.

The methods used in suicide differ both between the sexes and between rural and urban

areas. Kall and Dr Kumar both say people in rural areas are more likely to use pesticides

to end their lives.

Dr Kumar says use of drugs is increasing among urban adolescents as a form of "chronic

suicide", and that in the city, "drowning is more common among women, and

hanging among men".

Officers from Police Protection Unit 3 in Phnom Penh say suicide by drowning is common.

More than 30 people, mostly women, have attempted suicide from the Japanese Friendship

Bridge this year. The unit managed to save 20 of them.

Raising awareness of issues surrounding suicide is key to prevention. TPO runs three

one-hour radio broadcasts each week on FM 96 and 99.5, and invites callers to share

their problems with an on-air counselor.

The NGO says its innovative approach has been successful, but the limited number

of NGOs and government institutions providing mental health support means there is

an urgent need both for more counselors and support services.

That is something the government recognizes, and the Ministry of Health (MoH) has

been working with the International Organization for Migration on a mental health

project to train psychiatrists and psychiatric nurses.

Twenty psychiatrists have graduated to date from the nine-year-old project and are

working in hospitals across the country. But Mam Bunheng, secretary of state at the

ministry, worries that this is insufficient.

"We need at least one psychiatrist for each of the 62 provincial and district

hospitals," he says. "We will train more nurses and specialists. We are

worried about mental health - it is a priority."

Experts state that blaming Cambodian culture for a lack of support services is counterproductive

and unfair to an impoverished society that has suffered unique stresses. Dr Kumar

says that "pointing the finger at society" is not a constructive way to

look at the problem.

"Society has recovered marvelously well," he says.

TPO's Kall says a healthier economy, better education, and a satisfactory system

of social justice should help reduce the number of suicide attempts. However he admits

there will always be those for whom it seems the only option.

"Committing suicide is not part of the culture, but [if] people have nowhere

to go, it is their last choice," he explains.

Kall says Cambodians are well aware of the lack of support available to those who

encounter difficulties: there is even a saying for it, he explains.

"You go down to the water and there is a crocodile; you come up to the dry land,

and there is a tiger; if you escape into the forest, the thorns will cut you; and

if you go to the market, the police are there."