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Holocaust Survivors and Survivors of the Cambodian Tragedy: Similarities and Differences Dan Savin, M.D. and Shalom Robinson, M.D.
Many Cambodians also carry mental scars nearly 20 years after the Pol Pot reign ended. The stories of the interviewees presented here illustrate the terrible suffering of millions of Cambodians during the Khmer Rouge regime, as well as the psychological late effects caused by this suffering. All six interviewees display posttraumatic stress symptoms. Four out of six meet DSM-IV criteria for PTSD, and the other two have significant symptoms. The first author has found posttraumatic stress symptoms in hundreds of Cambodians whom he examined during his two-and-a-half-year stay in Cambodia. In a group of 100 Cambodian child survivors interviewed in a refugee camp near the Thai border 13 years after the end of the Pol Pot regime, 46% met full DSMIII-R criteria for PTSD, and an additional 40% met the lesser criteria for a diagnosis of PTSD not otherwise specified (NOS). (22) In another group of Cambodian child survivors who made it to the United States and were interviewed around the same time, 28% met full criteria for PTSD, and an additional 20% for PTSD NOS. (15, 21, 22)
Thus, Cambodians and Holocaust survivors are highly traumatized populations, and continue to suffer from posttraumatic symptoms many years after the major trauma has ended. Situations which may have some association with the original trauma may cause exacerbation of the posttraumatic symptoms. This was found in Holocaust survivors in Israel during the Gulf War (20) and also in Cambodians during the times of political instability, as seen in some of the interviews in this paper.
The attitude of Holocaust survivors toward what happened to them during the terrible years of their persecution changed over the years. Many say that they survived because they did everything in their power so that they would be able to tell the world what happened to themselves, their families, their communities, and the Jewish people in Europe. They felt an overwhelming imperative to bear witness. The wish for revenge also constituted a strong drive to survive for many persecuted Jews. (9) This attitude partly changed after the war; (18) acts of revenge were rare. Many of the Holocaust survivors were ill, and needed medical help after the war. Most suffered from PTSD symptoms. A common aim was to rise from the ashes, build families, and seek a better future. Many emigrated from Europe to Israel, the United States, Australia, and other countries.
For many Cambodians the wish for revenge was initially quite strong, and with Pol Pot still at large this wish is still considerable. As with survivors of the Holocaust initially, most Cambodians since the Khmer Rouge regime have primarily been concerned with improving the living situation of themselves and their families. Some Cambodians emigrated to countries such as the United States, France, and Australia after the years of terror. It was mainly survivors from this group of emigrés who first began to speak to the world about their experiences. (16) Their living situation has been more stable than that of their counterparts in Cambodia and they have had more access to the Western media. Recently, however, we have begun to hear more voices from Cambodians in their own country.
In interviews for this study, Cambodians were asked whether or not they feel guilty about anything that happened during the traumatic years. Invariably, the answer was negative. We believe, however, that their answer was colored by inexact translation of the English word "guilt." In Khmer, the translation of "guilt" is koh, which also means "wrong," implying actual wrongdoing rather than just the feeling that one has done something wrong. This probably explains why interviewees in this paper did not speak much about the issue of guilt. By talking with Cambodian survivors in more detail, however, it becomes clear that guilt is a major issue for them as for Holocaust survivors. Cambodian survivors wish they would have given deceased family members more of their own food, or speak of feeling badly about taking the clothing of a deceased relative. Many describe guilt feelings for not having been able to perform a proper funeral ceremony for their loved ones.
A central function of any culture is to provide traditions, institutions, and value systems that can protect members from being overwhelmed by stressful experiences. (15) A culture helps to maintain social relationships and social structure. Just as intense trauma may cause permanent changes in individuals, it may cause permanent changes in the cultural system as a whole. (7) Jewish society will never be the same as it was before the Holocaust. Similarly, Cambodian society has been irreversably altered by the period of the Khmer Rouge regime.
The degree of trauma experienced by an individual is to some extent a result of both the severity of the trauma, and the supportive capacity of the environment. In recovery from trauma, the most important first step is to ensure that the individual is in a safe environment. Since the end of World War II, much has happened within the Jewish community to make the environment more supportive and safe for Holocaust survivors.
Jews who came to Palestine before the Jewish state was proclaimed in May 1948, in the years after World War II, encountered a society preparing itself for its War of Independence. They helped the young country fight for its survival both militarily and economically. People in Israel were not ready in those years to hear about the Holocaust. The survivors who at first wanted to tell their story soon closed up. In 1961, the shock of the Eichmann trial caused a breakthrough, changing the attitude of Israeli society toward the Holocaust and toward the Holocaust survivors. Since then, Israelis have become much more interested in what happened during the Holocaust, and survivors have recently become more willing to tell their stories.
Unfortunately, in the 18 years since the end of the Khmer Rouge regime, Cambodia has not yet been able to create a safe and supportive environment for its people. Rival political factions continue to fight for control of the government with continued loss of life. Because the tragedy was inflicted by Cambodians on their own people, Cambodians in general do not trust their government (or even their neighbors). Corruption runs rampant and the community remains fractured. So far, the situation has reinforced the notion that living with corruption, injustice, and warfare is just part of being Cambodian. (2) Many Cambodians live with the constant fear that what happened during the Pol Pot regime could well reoccur.
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