Sin Sokhan in her prison cell, mid-January.
Her clothes lie in a heap outside the prison door.
WHEN Ty Saran returned home from work on 7 January, he stumbled across a scene that
will haunt him forever. His wife, Sin Sokhan, sat silently on the floor of their
dingy, poorly-furnished house, refusing to speak. Just feet away, in the kitchen,
Saran found the body of their six month old child in a pool of blood. He had been
slashed to death with a kitchen knife, and decapitated.
Saran tried to communicate with his wife, but she seemed lost in her own world. It
was only later that night that she awoke with a start, sat bolt upright and began
begging her husband for "three drops of blood" from his finger. When he
refused, Sokhan bit him on the mouth, drawing blood.
The next morning, Sokhan was arrested, thrown into prison and charged with voluntary
manslaughter. Shackled to the cell's barred door, she refused food and water, tore
off her clothes and blankets that the prison guards put around her, and cut her hair
with a razor blade. All the time she refused to communicate with anyone.
This horrifying story brings into sharp focus one of the great taboo health problems
that plagues Cambodia, a problem which is widespread, rarely discussed, and devastating
to those affected - mental illness.
"Maybe only one to two percent are as seriously disturbed as this woman,"
said Kann Kall, Vice Director of the Transcultural Psychosocial Organisation (TPO).
"But most of the population faces some kind of mental health problem."
When patients list their physical complaints, he explained, very often at the root
of all their symptoms there is a psychological trauma. "They might complain
of constant headaches or difficulty sleeping," he said, "but when you ask
them why they can't sleep, they say, 'Oh, because I think about my son who died in
1978. I think too much, I have no energy'."
Yim Simen, lawyer for Sin Sokhan, agreed.
"Before 1979 we had very few people with mental disease, but now there are more
and more falling mentally ill," she said. "People demonstrate their illnesses
in different ways. Some sit alone quietly, some take off their clothes and wander
down the street, some steal property, and others get violent or shout."
While mental health experts agree that severe and persistent mental illnesses such
as schizophrenia are found in approximately the same percentage of the population
here as the rest of the world, most believe that the psychosocial distress left by
years of traumatic events, isolation an insecurity has taken a great toll on the
general mental health of Khmers.
"The traumas these people have gone through diminish their ability to cope with
life, " said Ellen Minotti, transition advisor for Social Services of Cambodia
(SSC). "They don't talk to each other about their stresses, and they also don't
recognize mental illness in the same way that we would in the west."
All these factors make it a difficult problem to tackle in a country already tragically
ill-equipped to cope with mental illness, whether mild depression or psychosis. Before
the Khmer Rouge took power in 1975, the country had just 12 psychiatrists. When they
disappeared, so did Cambodia's entire mental health system.
The new generation of psychiatrists has been slow forming - it was only last year
that the first 10 trainees graduated as qualified psychiatrists. The Ministry of
Health has one only staff dedicated to mental health, and there is no hospital or
center dedicated to treating long-term mentally ill patients. Buddhist monks, often
cited as sources of support for the community, are not trained to deal with different
types of mental distress. Many severely mentally ill people are untreated and are
found chained or tied to trees, houseposts or beds, their families unable to cope.
With so few resources available, say the experts, it's inevitable that many of those
in desperate need simply slip through the net.
There are varying ideas, however, on how the issue should be tackled.
"Many people think that the government should be setting up mental health centers
across the country, " said Kan Kall. "But in my opinion, this is not a
helpful solution. The government should integrate this whole issue into primary health
care, so that information spreads around the communities to help them help themselves.
The communities need to know how to respond, and the families need to know how to
Cambodia began using psychotropic drugs in 1994 to treat mentally ill patients, but
Kall believes that there are drawbacks to this too.
"Now, every family with a psychotic patient on medication is happy because he
seems better, but I often wonder, are we helping them or poisoning them? What if
the NGOs who provide the medicine have to pull out tomorrow?" In contrast, he
said, information and education on coping with mental illness was cheap and much
Minotti agreed that a reliance on drugs was not the answer. "It would be incredibly
cruel for them to lose that grip on reality if their medication was taken away,"
Because mental health issues are not so immediately obvious as malnutrition or poor
sanitation, said Minotti, there has been very little government money forthcoming
to deal with this vulnerable section of the community.
"It's just a dream in the Ministry of Health," agreed Kall. "They
set up a mental health subcommittee, but it has no funding and no function."
To try and put this imbalance straight, the six mental heath NGOs who work in Cambodia
are currently putting together a funding proposal for the upcoming Consultative Group
donors' meeting in Tokyo. They are asking for funding for media campaigns, training,
and a comprehensive plan for the development of the mental health system. As the
draft proposal says, "Mental health is not a frill to be addressed after peoples'
development needs are met - it is an essential step that should be integrated in
the process of reconstruction and development."
Donors should remember that mental health issues affect not only the patient, but
the family and community around them, said Kall. "If only one percent of the
community had a mental illness, we could safely say that at least ten percent of
the population would be affected - family, friends and community who have to look
It's certainly a lesson that Sin Sokhan's family is learning now. She was released
from prison on January 21, after a combined effort from Legal Aid of Cambodia, prison
and police authorities. All charges of voluntary manslaughter were dropped, after
a doctor's report certified her as 'insane'. She now sits at home and waits to see
what will happen to her. Her husband goes to Norodom Hospital every day to get medication
for her, and TPO is taking steps to provide her with the support she needs to recover.
But one painful step still remains - Sokhan has no idea what happened to her child.
"She asks where the baby is," says Yim Simen. "The neighbors tell
her he is staying with some relatives. I don't know how we can tell her what she's