Sitting upright, the patient described his symptoms. For three years he has suffered from dizziness, headaches and a short temper. “I think too much, and it seems like my brain isn’t working well,” the 44-year-old villager said Wednesday.
He is haunted by a tumultuous childhood, he said. His parents divorced when he was 8, and his stepmother abused him. In his village he watched Khmer Rouge militias torture and kill innocents. Once, when he was working the fields, he was caught stealing a potato. Cadres tied him to a tree for several days.
With the National Mental Health Plan, a 20-year strategy for updating Cambodia’s ability to treat mental illness waiting for Ministry of Health approval, the Outpatient Psychiatric Department at Preah Sihanouk Hospital is a window into how psychiatry might help Cambodia clear the traumas of the past and ease the difficulties of today.
Dr Ang Sody, one of the “first generation” of Cambodian psychiatrists to graduate from a Norwegian-funded program in 1998 is one of six psychiatrists working at the OPD, Cambodia’s largest facility for treating mental illness. About 200 patients visit the clinic daily, between 30 and 40 for their first visit, she said.
Patients pay 3,000 riel per visit. The price includes any medicine prescribed by the doctor.
Dr Muny Sothara, a psychiatrist at the clinic, said he often encounters patients suffering from anxiety, depression schizophrenia and “organic brain problems,” the same disorders psychiatrists treat everywhere.
The difference is in number. Dr Ka Sunbaunat, an author of the plan, estimated that 60 percent of those who survived the Pol Pot years suffer from mental illness, while rampant poverty, drug use and sex work cause it in younger Cambodians.
Furthermore, Muny Sothara said, any apparatus that existed in Cambodia for treating mental illness disappeared with the Khmer Rouge regime.
Widely misunderstood in the country, mentally ill patients are still often shackled by their neck and legs or locked in rooms, Ang Sody said.
And most Cambodians likely have never heard of psychiatry. According to the report, Cambodia has 20 psychiatrists with offices in fewer than half of the country’s provinces.
Muny Sothara explained that they have adapted psychiatry to Cambodia’s customs and resource limitations. With only a few doctors, there is more emphasis on drugs than counseling sessions.
“Cambodians expect to get medicine when they go to the doctor,” he said. “It makes them feel like real patients.”
They have also tied psychiatry to Buddhist beliefs.
For example, to those patients contemplating suicide, doctors explain that it is “bad karma” and will not benefit them in the next life, Muny Sothara said.
Though on a relatively small scope, the clinic is booming.
“Our main worry is that the clinic will become more famous,” Dr Sin Poly, an OPD psychiatrist, said.
But for the time being Cambodia lacks the ability to treat this massive problem and the Ministry of Health has yet to approve the 20-year plan, let alone secure funding for it.
“I hope it happens faster,” Muny Sothara said.