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Perhaps no country in asia needs mental-health care more than Cambodia, a tormented nation where the scars of the 1975-79 Khmer Rouge regime are still fresh even a quarter-century later. According to a survey conducted by the Transcultural Psychosocial Organization (TPO), an NGO with ties to the WHO, 75% of adult Cambodians who lived through the Khmer Rouge era suffer from either extreme stress or post-traumatic stress disorder. Children born to this broken generation haven't fared much better. Aid workers estimate that 40% of young Cambodians suffer from stress disorders caused by growing up in a tattered social network. Yet in all of Cambodia there is not a single inpatient mental hospital. The nation of 11 million has only 20 psychiatrists. Mental-health funding didn't even figure into the national budget until nine years ago. "The mental-health situation is bad in many countries," says Muny Sothara, a psychiatrist at an outpatient clinic at Preah Bat Norodom Sihanouk Hospital in the capital, Phnom Penh. "But I don't know of any place worse than Cambodia."
Every day, hundreds of bedraggled citizens line up from dawn at the Preah Bat hospital's mental-health clinic. Most have traveled for hours by oxen-drawn cart or packed bus to reach the venue. Chan Muoy, a gaunt, 41-year-old snack vendor, has not been able to sleep soundly for years. Images of past torture creep into her mind before slumber does. Now, though, things have got even worse. Cambodia has just gone through dangerously polarizing parliamentary elections, and many fear that violence might erupt once again. So nervous is Chan Muoy that she has lost her appetite and the tortured flashbacks are beginning to blur the line between reality and hallucination. While speaking to a psychiatric nurse, Chan Muoy's eyes bulge out and dart wildly as she recounts her trauma: how her father, brother and sister were killed by the Khmer Rouge, the latter for the crime of stealing a potato; how a troop of machete-wielding child soldiers came to get her one night when she was 18 and lashed her to a post in crucifixion pose before inexplicably releasing her hours later; how she wandered the streets for years after that, suffering rapes and beatings. "Everyone has gone through hard times here," says Chan Muoy, who was diagnosed with post-traumatic stress disorder by the nurse. "I'm not unusual. We all relive bad memories that make us shake and cry."
The lack of mental-health infrastructure gives Cambodians few options to treat their woes. Kum Kim, a 47-year-old from Kampong Thom province, was diagnosed as a schizophrenic by a health worker from TPO earlier this year. She says evil spirits poke sticks through the floor slats sometimes when she is resting in her wooden, stilted house. She says she must hop around her home to avoid the sharp jabs. Desperate for help, she goes to a krukmai, or witch doctor, named Son Mao. The krukmai's housethe only one in the village whose owners can afford a corrugated iron roofhas been prepared for Kum Kim's visit. There is an offering of fruit on the floor and whirls of incense meant to lure the village spirits in for a chat. As pigs squeal nearby, the krukmai touches Kum Kim's forehead and conjures up the spirits. They tell her that Kum Kim has been possessed by evil spirits. The reason? While Kum Kim's husband was commune chief many years ago, he promised to build a road for the village. Yet he never did. Now, the spirits are out to punish the whole family. "If the spirits are angry, you have to soothe them," explains Son Mao. "Once they forgive you, your craziness is gone."
Despite the krukmai's ministrations, Kum Kim's craziness has not disappeared. The spirits in her house still jab her with pointed sticks. Other families in the village have begun shunning her family, worried that the spirits might haunt them, too. In Cambodia, though, the haunted seem too numerous to avoid. "So many people are sick in the head here," says Chea Dany, a nurse at the Preah Bat hospital. "But no one wants to be with them. Our society is divided into two: people who are sick, and people who are O.K. and want to ignore the sick. We cannot grow up as a country if we are divided like this."