Cambodian ‘Broken Courage’ after Trauma Different to PTSD, Study Says

Many Cambodian victims of trauma suffer from “baksbat,” or “broken courage,” as opposed to the Western derived post-traumatic stress disorder, a researcher said yesterday.

In an interview, Dr Sotheara Chhim, executive director of the Transcultural Psychosocial Organization, said baksbat differs from PTSD and has additional symptoms according to data collected last year. “Baksbat is a Cambodian response to trauma,” Dr Chhim said. “I want people to know that PTSD does not fully cover all the relevant symptoms in Cambodia.”

The Khmer term baksbat, which literally means to break form or body, describes a person suffering from a psychological breakdown of courage, he said, noting that usage predates the Khmer Rouge regime and results from a variety of traumas.

Fifty-three experts, including health staff and linguists, were consulted to describe baksbat, then a quantitative survey conducted among 390 patients receiving mental health services from the TPO in 2009, he said.

“I found more symptoms expressed in baksbat than in PTSD,” Dr Chhim said, adding that only psychological distress, out of three components identified in baksbat, including broken courage and loss of self, showed similarities to PTSD.

One additional symptom found was “dam doem kor,” which directly translated means “plant the mute tree,” referring to an inability to see, hear or speak out, he said. Avoidance was present in PTSD, but Cambodian idioms more fully captured the unique Cambodian experience of avoidance, he added. Also “loss of togetherness is not mentioned in PTSD.”

Dr Chhim said he hoped to further the research, which was for a PhD thesis at Monash University in Australia. “In the long run, this is the first step to develop a syndrome. Then I can see if it is possible to develop a management strategy.”

In Cambodia, Western-based approaches dominate mental health services, with research between 2000 and 2009 identifying different rates of PTSD in Cambodia ranging from 7 to 28.4 percent, he said. “I want Cambodian mental health professionals to [recognize] ethno-cultural responses instead of just looking at Western diagnostic criteria and fitting it to Cambodia.”

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