We would like to respond to comments published in your article "Mental-health workers preparing for KR trial fallout" (Post, September 23, 2005).
In the article, the author Markus Bernsen, quoted Dr Chhit Sophal, as making the following statements, namely that it would be "hard to persuade people to seek counseling", "that few Cambodians would understand an information campaign like the one proposed by TPO and SSC" and "It's useless...the campaign will be a waste of resources".
We felt that the author did not provide the context and background in which the statements were made, which in turn laid the quotes open to misinterpretation and misunderstanding. However, the following response aims to provide the relevant background information that was omitted from the original article.
After more than 10 years experience, the Transcultural Psychosocial Organization (TPO) and Social Services of Cambodia (SSC) have found that their continuing activities, which include awareness-raising, as well as direct interventions, are well received by Cambodians. There is formal and informal evidence to support the validity, acceptability and benefits of mental health services.
As mental health professionals, we foresee that many Cambodian people's terrible memories, fears and anger will be reawakened by the process of the Khmer Rouge tribunal (KRT) and there will be a great need to support them. Similar concerns were raised during the preparation for the Gacaca trials in Rwanda and the Truth and Reconciliation Commission in South Africa. The concerns expressed were threefold:
1. Re-traumatization of all survivors, especially those called upon as witnesses;
2. New trauma inflicted on children, both those who were very young and born after the genocide, as they were exposed to vivid images of the violence; and
3. Renewed anger and hostility by the victims as they relived the testimonies given during trial.
Successful approaches were developed to address these concerns and to promote healing and reconciliation.
TPO's well-documented research and activities have also shown that counseling is just as effective as treatment with medication. Counseling is a sustainable type of intervention, which gives people emotional support and tools to help cope with future problems. The approach proposed by TPO and SSC for mental health intervention is consistent with worldwide research and programs to address and promote healing and reconciliation within post-conflict countries.
Comments in the article also questioned the accuracy of the prevalence rate for post-traumatic stress disorder (PTSD) in Cambodia. Dr Chhit Sophal's figure of 2 percent to 3 percent was based on a group of psychiatric out-patients while TPO's figure of up to 28.4 percent was based on community studies in which the diagnosis of PTSD was specifically sought. In addition, Dr Chhit's low figure may be due to the fact that the patients may have not been asking trauma-related questions because the staff have a hard enough time just meeting the needs of several hundred patients attending the Psychiatric Clinic each morning. Prevalence rates do vary according to the population sample and the screening measures used. They are also difficult to estimate, given the tendency for sufferers to avoid seeking treatment, either due to the fear of being labeled "weak" or "crazy" or due to a reluctance to leave the comfort zone of their homes. Nevertheless, TPO's figure quoted is comparable to other prevalence rates in post-conflict countries: Algeria 37.4 percent, Ethiopia 15.8 percent and Gaza 17.8 percent.
The KRT is a unique event in Cambodian history, which may cause the re-emergence of psychological wounds that have been buried for many years. As mental health professionals we feel we have a moral obligation to help our fellow citizens, using the skills that donors have helped us to learn and practice over the last 10 years. And we feel that mental health support services around the KRT will be essential to the wellbeing and reconciliation of all Cambodian people.
Dr Sotheara Chhim, Director of TPO Cambodia
Ellen Minotti, Director of SSC