Bo Hoeun, 44, was just a small child when her family was sent by Pol Pot’s soldiers to work at a labor camp in Battambang province’s Mong Russei district.
“During the Khmer Rouge regime I saw human bodies laying dead after soldiers killed them. It was often that I would see fresh blood on trees,” she recalls.
After the fall of the regime, her family was torn apart by another trauma: domestic violence. Ms. Hoeun’s father regularly beat her and her four siblings.
Tortured by sleepless nights, she spent most of her adult life battling inescapable feelings of sadness, anger and disappointment.
“I did not know I have mental health problems, but day to day…I had no confidence in myself and could not finish any job. My health became weaker and weaker and I weighed only 30 kg,” she said.
Ms. Hoeun twice sought help at hospitals—in the late 1990s and again in the early 2000s—but on her first attempt could not access a mental health specialist due to high demand for treatment. The next time, a doctor prescribed medication but never offered any counseling.
Noticing the tablets were making her tired and ill, she eventually abandoned them.
It was not until May 2011 that she was introduced to the Transcultural Psychosocial Organization (TPO), an NGO that offers support to people with mental health problems.
Ms. Hoeun was diagnosed with post traumatic stress disorder (PTSD)—a disorder that arises in response to traumatic events and includes symptoms such as flashbacks, upsetting dreams, and emotional distress. She began a two-year course of Eye Movement Desensitization and Reprocessing (EMDR) treatment.
The therapy is the newest of two approaches recommended by the World Health Organization to treat PTSD—the other being the more well-known cognitive behavioral therapy (CBT)—and is based on the idea that “negative thoughts, feelings and behaviors are the result of unprocessed memories.”
Psychologists use techniques to stimulate eye movements in order to process these memories, a method that Ute Sodemann, the internal monitoring officer for the Mekong Project II, which is trying to spread the use of the treatment in Cambodia, said is not yet fully understood.
“When you have your [Rapid Eye Movement] sleep, your eyes move from left to right because your brain is removing things it does not need, it is processing,” she said. “So, we ask the patient to think of the traumatizing event and then do the eye movement.”
“Not even neurologists have gone so far as to fully understand why this works,” Ms. Sodemann added.
The Mekong Project II is the second stage of a push by the organization EMDR Cambodia to bring this therapy to Cambodians free-of-charge through their NGO partners, such as TPO.
Launched in November, it aims to treat about 1,250 PTSD sufferers over two years. An earlier project saw 14 psychologists and two psychiatrists receive training in 2011, six of whom are using EMDR with patients across Phnom Penh.
Later this year, 30 psychologists graduating from the Royal University of Phnom Penh (RUPP) will be trained in the technique, while the Health Ministry has also shown interest, according to Mekong Project II director Ean Nil.
But not all experts agree that the treatment is the right option for Cambodians, who are seven times more likely than the average human to experience PTSD, according to a 2012 study by RUPP’s department of psychology, which found that 2.7 percent of people in the country above the age of 21 exhibit symptoms of the disorder.
Peg LeVine, a professor at the U.S.-based Shoah Center for Advanced Genocide Research, said the use of some trauma-based treatments in Cambodia were problematic as they hailed from “non-Buddhist and non-animist regions of the globe” and did not consider traditional rituals or distinct spiritual needs.
“CBT and EMDR and Forgiveness modalities carry a person-centric approach to therapy, and their origins are urban born, and much of the sampling in research is urban based,” Ms. LeVine said in an email.
“Quite bluntly the question about trauma and therapy is a political one…. It is easy to see in the context of Cambodia how university departments and NGOs are in double binds if they turn down funds,” she added. “And with funds for training come funds for research with surveys that show efficacy, mostly.”
TPO’s executive director Chhim Sotheara said the issue lies not with the treatment, but with the definition of the disorder.
“I use a concept called broken courage, which describes better the way Cambodians face trauma. In my experience very few people in Cambodia meet the criteria for PTSD because the concept is too narrow,” Dr. Sotheara said.
Yet nearly two years after finishing her treatment, for Ms. Hoeun, at least, EMDR has been a success.
“Before, I felt like I wanted to commit suicide and thought my life was meaningless but now I feel relieved,” she said. “My life has value and is not hopeless.”