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Nightmares Among Cambodian Refugees: The Breaching of Concentric Ontological Security

  • Special Section: Trauma and Dreams
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Abstract

This article explores the nightmares of Cambodian refugees in a cultural context, and the role of nightmares in the trauma ontology of this population, including their role in generating post-traumatic stress disorder (PTSD). Among Cambodian refugees attending a psychiatric clinic, we found that having a nightmare was strongly associated with having PTSD (χ2 = 61.7, P < 0.001, odds ratio = 126); that nightmares caused much distress upon awakening, including panic attacks, fear of bodily dysfunction, flashbacks and difficulty returning to sleep; that nightmare content was frequently related to traumatic events; that nightmares resulted in a decrease in the sense of “concentric ontology security” (i.e., in an increased sense of physical and spiritual vulnerability in a culture that conceives of the self in terms of concentric, protective layers), including fears of being attacked by ghosts; and that nightmares frequently led to the performance of specific practices and rituals aiming to extrude and repel attacking forces and to create “protective layers.” Cases are presented to illustrate these findings. The Discussion considers some treatment implications of the study.

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Notes

  1. Connor’s (1982) makes similar observations about the Balinese self, referring to it as an “unbounded self”.

  2. Sleep paralysis occurs just before falling asleep or immediately upon awakening: though conscious, the person cannot move and often sees a shape coming toward him or her; when the shape arrives at the body, the person often experiences severe shortness of breath along with other symptoms. The inability to move may last several minutes. Cambodians with PTSD often have sleep paralysis and usually consider the approaching shape to be that of an attacking demon or ghost (D. Hinton et al. 2005a, b); they refer to the events as khmaoch sangkât, literally “pushed down by a khmaoch”.

  3. According to the first author’s patients, and monks he has interviewed on this subject, an individual can strengthen security spheres, or rings, through two methods: by directly increasing them and by removing forces that weaken them. Let us take the example of the “merit” and “good luck” layers. Merit has its negative counterpart, namely, “demerit” (baab); “good luck” (riesey) has its negative counterpart, namely, “bad luck” (kruah). In ritual practices, baab and kruah are configured as a sort of dirt that can be removed, a sort of kryptonite that decreases the power of the protecting levels, that lowers resistance to khmaoch and other assaults. A sorcerer, at the behest of one’s enemy, may send inauspicious objects into the body (da ampoe), called ampoe; most commonly, the negative objects are iron nails, hair or leather. The ampoe weakens the body and decreases its protective layers, causing the person to fall ill, especially with stomachache. There are several rituals that simultaneously remove ampoe, remove kruah and increase riesey. Almost all ceremonies that raise good luck also remove kruah: water anointing “washes away” kruah. Many ritual officiants create a sense of efficacy by invoking phrases like “raising riesey,” “washing away kruah,” “making merit,” “getting rid of demerit” and “refreshing the body”—with “refreshing the body” suggesting a state of coolness and moistness that connote increased bodily energy.

  4. Many Cambodians at our psychiatric clinic have nearly drowned when working or playing in rivers and ponds, especially in the rainy season, when much flooding occurs. This is a deeply disturbing event that is vividly recalled.

  5. A nightmare may be a “reliving,” a re-experiencing, of past traumas in yet another way. The nightmare event is not only content and emotion, but also the somatic symptoms experienced in the nightmare, and those somatic symptoms may recall traumatic events during which those same somatic symptoms were experienced. That is, the nightmare may recall a trauma owing to its content, emotion, cognitive appraisal and somatic symptoms.

  6. In the case of abstract-theme-reliving nightmares, and sometimes that of theme-type reliving nightmares, it was difficult to determine whether a nightmare resulted from past memories or whether it did not arise from past memories, but evoked past memories upon awakening; that is, it was difficult to determine whether it was a trauma-recall-generated nightmare or just a trauma-recall-causing nightmare. For example, PTSD creates a sense of “threat,” which may generates nightmares with the theme of threat, and then those threat dreams may well recall various traumatic experiences of when one was threatened. In this case, the nightmare was PTSD-caused, but not trauma-recall-caused; but such threat dreams could also be generated by past traumatic experiences of threat.

  7. In other cultural contexts, a similar “soul wandering” interpretation of dream experience is found (e.g., Herr 1981; Hollan 1989).

  8. In the Cambodian context, the reality of the various types of khmaoch is vividly illustrated in a music-based healing ritual, a ritual that involves possession (phleeng area). Though this ritual is not performed in the United States, it was common in the pre–Pol Pot period, and almost all of the patients at the psychiatric clinic have observed them. In the ritual, the healer becomes possessed by various khmaoch—never a deity. The khmaoch appears and indicates the reason for the person’s illness; the khmaoch may be someone who died and has not yet been reborn, a prioey, a beysaach, even an aap. By way of contrast, in Laos, during traditional music-based possession rituals, the possessing entity is always a god, never a demon or dead person (Hinton 2000).

    Also, highlighting the fear of khmaoch among Cambodians, a traditional blessing is the following: “May you live to be so old that a banana squirts from your mouth when you bite down, so old that the corn kernels fall down to the ground when you bite down on a corn cob, and may it be that a khmaoch, despite using all its tricks, is unable to harm you” (kham cheek rebout, kham poat roebeh, khmaoch tdoal damreh, twoe meun troev).

  9. A person who studies black magic may become an aap. As that person sleeps, his or her head rises from the body, carrying along only the intestines; the head, along with the dangling intestines, floats off in search of blood and other refuse to eat. It will suck the blood from small animals like frogs; the pale corpses, drained of blood, are often found in the fields. If an aap comes near someone, the person will become ill, usually with a stomachache.

  10. The traditional Cambodian house is built on stilts; below the house, water tends to accumulate, and refuse also, so that it becomes a smelly sink. Khmaoch and aap like to eat this matter. Also, after a woman gives birth, aap and khmaoch like to come to the house to consume the blood and placenta from the birthing. An aap and various kinds of khmaoch, especially a priey, will make one ill if they come near, most commonly causing stomachache. To prevent this, if a woman has given birth, or if it is thought that bouts of stomachache are caused by an aap or khmaoch visiting the area under a house, a plant with thorns will be placed under the house.

  11. In some cases, a deceased relative may cause a “lured-away nightmare.” The deceased relative misses one, so may try to lure away one’s soul; if the soul goes with the relative, death may occur, with the soul doomed to wander the earth along with that of the relative.

  12. It should be noted that “survival guilt,” played out in the idiom of rebirth concerns, is often conjoined to another type of guilt: guilt at being unable to provide financial help to relatives living in extreme poverty in Cambodia, relatives who, not uncommonly, call to ask for financial assistance. Just as the patient may have watched relatives die in the Pol Pot period, unable to help, this same drama is seemingly playing out again when he or she is unable to send money to relatives in Cambodia who are in a dire financial or medical situation.

  13. One can also make merit for any khmaoch (or a demon, such as an aap) that one sees in one’s dreams; this speeds their rebirth and calms their anger, so that they will cease their harassment.

  14. During phoechum bun, the family goes to the temple to perform certain rituals. Each family offers food to the monks and gives them a piece of paper on which is written the names of deceased relatives. While the monks chant, an assistant to the monks, often an elderly woman, burns the piece of paper, while the family members pour water on the ground. Burning the paper helps to send the merit earned by the donation to the deceased, as does the pouring of water—a sort of cooling of those still in suffering, still not reborn. This ceremony is called bangsoekool. Bangsoekool can be performed at any time during the year—if one has a nightmare about a deceased relative.

  15. A patient who fears being “weak” searches the body for other weakness symptoms, for other weakness stigmata. This very scanning of the body and mind for stigmata leads to the “discovery” of symptoms; and the anxiety caused by the prospect of being “weak” leads to fear and autonomic arousal, to symptoms that “confirm” the patient’s fears of being weak, in a self-fulfilling prophecy.

  16. Cambodians have a conceptualization of illness that emphasizes “circular causation”: one element is both caused and causative—if a person is weak, then nightmares are more likely; and if a nightmare occurs, the person becomes weaker, which then predisposes to having nightmares. (This might also be called spiraling causation.) A nightmare is interpreted as a sign of physical weakness (and a nonsecured soul), which will increase hypervigilance toward the body and fears that even a slight sound may cause many symptoms, even death. In a weakened state, it is believed that the thoughts wander from worry to worry in a vicious and unstoppable repetition that further weakens the body; that the body is reactive to any stimulus, even a slight outer noise, causing the heart to race, which further weakens the body; that “khyâl attacks” frequently occur owing to poor circulation; that the soul is easily dislodged from the body, even by a slight fright; and that during sleep, the soul wanders far from the body, all the way to Cambodia, where it may be attacked.

  17. Of note, in several of the rites, not only merit, but also food, is sent to a deceased person. If a patient has had a dream about a deceased relative, especially if that person appears to be hungry or poorly dressed and cold, this creates great upset; in Cambodia, many people were observed to die by starvation, were subjected to the elements with minimal clothing. It is as if the relative is stuck in that purgatory. Merit making, offerings of food, and other rituals for the dead are deeply satisfying, relieving survival guilt, giving a sense of agency and bringing about a continuing, and reparative, relationship with the deceased.

  18. In a very elaborate ceremony to found a Buddhist temple, large iron balls are lowered into the ground around a temple to create its holy border; then monks chant for a long period of time, all the while holding a string that runs in a circle, from ball to ball. This ceremony is called “creating a holy perimeter” (poat seymaa). At the end of the ceremony, the string is cut, and the balls are buried in the ground; the string is made into wrist talismans that are thought to have special protective powers.

  19. These rituals resemble a traditional Cambodian New Year’s ritual in which one symbolically rids the body of “bad luck” by releasing a small boat—about 10 inches long—into a river or lake; and they have some similarities to the elaborate “getting rid of luck” (rumdâh kruah) ceremony, in which bad luck is transferred to a ritual object, which is often then floated down a river, or at least put in a location far from the ill person’s home.

  20. These placental and umbilical-cord coverings are given a special name: sâmnôm sângwaa.

  21. The special “birth kruu” is thought to reside in the head; if the head is touched, special ceremonies must be conducted or its protective power will be lost.

  22. A person having a protecting “birth kruu,” especially those born with the placenta or umbilical covering, are considered to be particularly powerful in magic and merit making, and will have special spiritual powers.

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Hinton, D.E., Hinton, A.L., Pich, V. et al. Nightmares Among Cambodian Refugees: The Breaching of Concentric Ontological Security. Cult Med Psychiatry 33, 219–265 (2009). https://doi.org/10.1007/s11013-009-9131-9

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