Treating people who have suffered so greatly in the past and the present, in my mind is a gift from my patient, my client, and my friend.  I say that not lightly, as my patients all influence me in so many personal ways and help to develop my professional skills along the way.  But it is their story that they are living, their story that they are sharing, and it is this sharing that makes them vulnerable, open, trusting, and hopeful.  As a Doctor of Psychology, I embrace and cherish that story as I guide and follow them through that journey of memories and deep internal emotions from the past to their present.  The patient guides the doctor and in turn is enlightened through my means and reflection.  I am grateful for this experience as so few in the world are given the opportunity to share something so personal and see it through another’s eyes.  Few take that time. 

I share this story as seen through the eyes, thoughts, images and words of one client who has suffered a great deal in her past from physical, emotional and sexual abuse, and at the age of 53 has chosen finally to confront this and change who she is, or at least the perception of who she is and once was.  This is a therapeutic but mostly a personal account of her story which she has chosen to share...

There is one more reason why I want to tell my story. Abuse makes one feels lonely and alone. Silence, secrecy, and lies. No one to tell,
too ashamed to tell. Even simple conversation deepens the gap, when
you're a child, you can not talk about your parents, or why you never
invite anybody to your place. When you're older, you have no childhood memories you can talk about. I will always feel different, because I will always see things, and process feelings and thoughts through what happened to me. Like people who have been through war, they will never be like the others who haven't. Although the difference is that war is something open, and public, what everyone suffers will be personal and different but there will be common ground. I think that abuse doesn't really allow you to be part of that sort of "community" because you always think that your story is unique and can not be told because of shame and guilt and fear. I hope that the book will help me and others not to feel so lonely anymore...

And I do feel terribly lonely tonight :-).

-B.

And so is her story that follows from our first conversations to the present. This is and will be an ongoing tale.

But is there some truth to this?  How much are they to blame?  Aren’t they the ones who are suppose to guide us and direct us through those fragile young years of our life as we try to go out on our own and become independent? 

What about these twenty-somethings  here in Cambodia who have often drastic differences and gaps between themselves and the multiple generations with whom they live and are influenced, and with whom they can be so far apart in culture, tradition, and even appearance, education and experience?

The young girl who is mocked for wearing sexy clothes, the young boy whose hair is too long, the young adult male who is in love, but must marry the woman who his family has chosen, or the woman who has been divorced and now told that she is “used goods and no man will want [her] again.”

The new generation, the ones who will someday run the country’s businesses and government, are left with few coping mechanisms in this modern world, with little social support, and even sometimes misguided education to adjust and develop in this rapidly changing Kingdom!

When we examine the difference in generations here in Cambodia it is important to consider the history in part.  There is small part of a missing generation due to the history of war and violence in this country, thus leaving a gap between the older generation, one that places its experience and functioning on tradition and culture; and a younger generation in their teens and twenties who are being dominated now by a global superculture that brings a great many influences, education, exposure, change, and different belief systems that conflict with the older methods and beliefs.  New things bring excitement but also challenges and conflict when this new way of being conflicts so strongly with the traditional belief systems of the older generation.  This external and internal conflict are what can lead to feelings of abandonment, lack of social acceptance, decreased self esteem, and often an internalization of strong feelings of guilt for rejecting the traditional culture, and thus their caretakers or parents.

What a struggle it must be for these twenty somethings to be exposed to modern technology, modern thinking about dating, sex and sexuality, education, socialization, and even family systems, but to feel guilty to partake and integrate some of those ways of thinking into their own sense of self and into their social lives.  Change is a powerful thing, but we have to be prepared to make changes and be accepted when those changes are in the end implemented.  For in the end, they impact who we are as individuals

This generational conflict, one that can be so divided and with so little buffer becomes a conflict for each young adult trying to grow up. He or she has no one they can share with, no one they can talk to and no one to go to when they have problems, questions, or are simply confused.  The older generation is not there to guide and the younger does not go to each other for support.

Take the example of a young man from a good family here in Cambodia, moderately wealthy, from divorced parents, and attending good schools but has come to terms that his sexuality is not of the mainstream – that he is gay.  He has struggled to find identity within that realm, to reach out to friends that for many years simply mocked him. 

“I go to parties and my father and his friends laugh at me.  My friends don’t understand and think I want to be a girl. Even my teacher at school tells me that being gay is wrong and that gay men have no penis and cannot have sex. I don’t know who I am or what I can do.  I don’t know about my future.”

But more importantlyare the strong conflict within himself and his family, the rejection by his family, the pull of all financial supports for his education and living.  Where does this leave him?  “I feel lonely and have no one to talk to.”  Not only in a place of depression and abandonment, but strong rejection and potentially at risk for a self destructive lifestyle.

This may not differ too much than even a western family and their reaction to the same news that their son is gay, but again, the supports in place are different.  A young adult has access to better education and to an environment in which he can find the social supports necessary to go through this struggle, in the best of cases.  He has been taught to seek out others in a time of need, to talk to others and to share his fears and anxiety.  Instead, the older generation here has taught them to suppress, to save face, and to not open up to friends as that is weakness and will bring shame to himself and his family. This leads to guilt and to an even greater self destruction.  This is worrisome. 

Where is this person or any other facing any problems to go?  Another client stated, “I have no one to talk to. My friends can’t understand and don’t want to talk about real things.  I would be laughed at if I went to therapy.” 

To open to others is weak and shameful.  So where do they go?  Only inside themselves where they may not be well equipped to handle the pressure of this changing world? Or outwardly destructive where alcohol, violence, self harm, and drugs can easily become a coping means? 

Why are we not teaching our kids?  Why are we not letting them understand society, the changes and how these influence us?  Are we afraid it may harm them?  How is this going to impact the future of them and this country?  Denial and lack of sharing/communication are so strong in this country that families hide everything. That is not protecting them from harm, but causing it.

Financial problems, as we know, are one of the largest causes of conflict, divorce, and domestic violence in the west.  What about when families begin to suffer in the new economy.  Do they talk to each other and share their stories? The sharing and knowledge that other people are dealing with the same issues is one of the most powerful means of coping with a problem.  But this is a culture where we are taught never to share, never to speak of problems, and never to open up to new ways of thinking.  Simply, we cannot.

I think of a recent case of a young girl who attempted suicide. She had a bright future and was from a good family, despite some family issues and now recent financial set backs.  She was understanding the pressures and stress that her family was under and her own stress trying to develop and understand a changing Cambodia and social status.  She even made attempts to talk to her friends about her plan, but even then her friends did nothing besides ignore it.

One of her friends at school told said she could not understand why no one helped.  “she told her friends it would be her last day alive, and they just said good bye.” They even went with her when she purchased the overdose she was planning to take.

Did they ask her anything, comfort her, talk to her? She had to save face for herself and for her family as she knew deep inside, although never communicated, that her family was facing a loss of status and that it would be terrible and shameful to her community.  She is now sitting in a coma on life support.  And her family is likely wondering how all of this could have happened. When her family was asked, they just said “when she gets better, we will have a big party to celebrate.”

Suppression.  This is modeled behaviour which is how we tend to learn the best.  This is copied from the older to the younger and reinforced by both generations.  It becomes a social construction and a major handicap to good development.  Supress!  Is this what the new generation is learning even when the problems that face them continue to grow at exponential rates and are far different than the ones that faced the traditional culture? 

A strong woman with confidence, education, and determination comes to treatment as she is suffering from a loss of individual identity and feeling as if she is only that of the family system, of a woman, of a Cambodian, but not of herself.  She talks about new experiences she wishes to engage in or explore, new thoughts and ideas, a new sense of power and being outspoken, “but the fear of shaming my mom and the guilt is too much.” 

“My mother wants to be close to me but does not understand boundaries.  She wants to know everything about me, but when I try to tell her about things, she tells me that young women should not discuss such things in private or public.  She looks at me with disapproval. I feel guilt, resentment and a burden to her”   -  a 27 year old female patient.

The outcome and potential dangers of this old school education and belief system is potentially devastating for the twenty somethings here.  Trying to cope in a rapidly changing country while being told not to change, to embrace old traditions, myths, and belief systems, without adapting them to this new world leads only to conflict inside.  The mental health risks and therefore social impact are considerable.  

And it is not just suicide.  Look around at our society.  Mental Health disorders are on the rise.  Some estimate it to be near 50 percent of the population.  Admittedly this includes PTSD from the war, but there are more pressing and contemporary psychological issues developing in Cambodia and being emphasized by the superculture and exacerbated by lack of resources, education, simple guidance, and coping means. 

Look and see how they are coping.  Substance abuse is on the increase, outward violence and self-harming behaviours are becoming more and more common. Marriage issues are on the rise as conflict occurs at home and we have no means of settling disputes beside the old ways of denial, alcohol, adultery, or worse, domestic violence.  Depression and anxiety developed from lifestyle and social or family issues with nowhere to go.  Fears and phobias and adjustment disorders, abandonment, social and developmental issues and even personality disorders.  Who is to blame?

But not is all so grim. As humans we are so capable of adapting, able to come through problems and to grow despite even the worse circumstances.  Cambodia suffers mostly from being exposed to the modern world and rapid exposure makes adaptation very complicated.  This change can lead to similar problems we see in the west as they will manifest in different mental health and physical health conditions.  It is through awareness and education, continued modeling behaviors that lead to acceptance and change, self-awareness and understanding of our own behaviors, and simply taking a chance to share and open up that are critical. Overcoming the fears, guilt, or shame that are associated is hard.

As a client made it clear, “no one understands how [I] feel and no one wants to listen.”

This is not something that is just part of Cambodia and its culture, it is something that is all over the world. My clients here are the same as back home, in some ways, but handicapped in others by this gap.

If we blame someone else for our problems, we don’t have to take responsibility.  But in the end, no matter who we can or want to blame, we are, in fact, the only ones left to deal with them – by ourselves, with our friends, support of our family, or of course a professional.  Assuming these simple resources are available to us and do not lead to further isolation or continue to increase the confusion, lack of trust, deception, and lack of intimacy between these generations. Yes, your children will have something or someone to blame!

As I see more clients with more contemporary issues it relieves me to see them get the help they feel they need, to fight the traditions and belief systems and social norms that they have learned, and to try something new. 

But where does it leave the young gay man with a now developing sense of self, but still no acceptance and tolerance by his family or friends – things we need so badly.  Or of the young girl who sits in a coma, who, if she recovers, will be shed with a grand party for living, but what got her to her current place will never be discussed? Or to the countless other people out there who are not even seeking help but hiding it away, just like they have been taught to?