Khmer Rouge Trials Offer Baseline Study For Mental Health Impact To A Society Of War Crimes Tribunal

ScienceDaily (Aug. 4, 2009) — As leaders of the former Khmer Rouge regime
testify in a human rights tribunal, in harrowing detail, for the killing of
more than a million Cambodians from 1975 to 1979 a central medical question
remains unanswered: will the trials help a society heal or exacerbate the
lingering affects of widespread trauma?

A new study offers insight, but sustains the paradox: more than 75 percent
of Cambodians believe the Khmer Rouge trials, formally called the
Extraordinary Chambers in the Courts of Cambodia, will provide justice and
promote reconciliation, but more than 87 percent of people old enough to
remember the torture and murder during the Khmer Rouge era say the trials
will rekindle "painful memories."

"Cambodians have high hopes that the Khmer Rouge trials will deliver
justice. However, they also have great fears of revisiting the past," says
Jeffrey Sonis, M.D., M.P.H., an associate professor in the departments of
Social Medicine and Family Medicine at the University of North Carolina at
Chapel Hill School of Medicine, lead author of the study that appears in the
Aug. 6 issue of the Journal of the American Medical Association.

"We just don't know how tribunals affect a society, whether they increase
mental and physical disabilities or relieve them," Sonis says. Sonis and
colleagues are now conducting a longitudinal study, funded by the National
Institute of Mental Health, to measure the effects of the trials on
Cambodians over time.

Preparation for the trials, co-sponsored by the Cambodian government and the
United Nations, began in 2006, 26 years after the collapse of the Khmer
Rouge under its leader, Pol Pot. The first public trial, of Kaing Guek Eav,
leader of the notorious Tuol Sleng prison, where thousands were tortured and
killed, began earlier this year. Accounts of the genocide estimate between 1
million and 2 million people were killed to create an "agrarian
collectivism" a communist concept for an ideal society.

Between December 2006 and August 2007 Sonis and an international team of
colleagues, including researchers from the Center for Advanced Study in
Phnom Penh, conducted a national survey of more than 1,000 Cambodians age 18
and older; 813 were 35 and older and would have been at least 3 years old
when the killings began.

More than 14 percent of respondents over age 35, and 7.9 percent of people
18 to 35, suffered from "probable postraumatic stress disorder" (respondents
met criteria on a common questionnaire, but did not receive an official
clinical diagnosis), which resulted in significant rates of mental and
physical disabilities. Previous studies have reported higher rates of PTSD
in Cambodians, but were mostly conducted among Cambodia refugees. The rate
(11 percent) of probable PTSD among all Cambodians over the age of 18 was
more than 5 times the rate among U.S. adults, based on the National
Comorbidity Survey.

Among the older group, half said they were close to death during the Khmer
Rouge era and 31 percent reported physical or mental torture.

Respondents who did not believe justice had been served, up to the time of
the survey, and those who felt the need for revenge were more likely to have
PTSD. Also, people who had more knowledge of the trial had higher rates of
PTSD. Yet most Cambodians had highly positive attitudes about the trials.

Another paradox emerged from the respondents: Almost half of the respondents
in this overwhelmingly Buddhist country thought the trials "go against the
teachings of Buddha." However, when asked about attitudes toward the Khmer
Rouge, 63 percent of respondents strongly agreed, and 21 percent agreed with
the statement, "I would like to make them suffer."

Tribunals to assess crimes of war and crimes against humanity are becoming
more common. In June, Charles Taylor, former president of Liberia, answered
questions in an international courtroom in Paris about his alleged role in
genocide in Sierra Leone in the 1990s. The International Criminal Tribunal
for the Former Yugoslavia, a UN-sponsored trial, has been underway since
1993 and the International Criminal Tribunal for Rwanda since 1995. The
Nuremberg Trials is perhaps the most well known.

The Khmer Rouge trials offer the opportunity to better gauge the efficacy of
these trials, and those lessons hold relevance across a spectrum of
injustice.

"The larger question raised by our study is whether attempts to promote
justice for survivors of violence – whether en masse or inflicted by one
individual to another – can help lessen its psychological toll," Sonis says.
"We simply don't know the answers yet."

Journal reference:

1.. Jeffrey Sonis, MD, MPH; James L. Gibson, PhD; Joop T. V. M. de Jong,
MD, PhD; Nigel P. Field, PhD; Sokhom Hean, PhD; Ivan Komproe, PhD. Probable
Posttraumatic Stress Disorder and Disability in Cambodia Associations With
Perceived Justice, Desire for Revenge, and Attitudes Toward the Khmer Rouge
Trials. JAMA, 2009;302(5):527-536 [link]
Adapted from materials provided by University of North Carolina School of
Medicine.
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University of North Carolina School of Medicine (2009, August 4). Khmer
Rouge Trials Offer Baseline Study For Mental Health Impact To A Society Of
War Crimes Tribunal. ScienceDaily. Retrieved August 5, 2009, from
http://www.sciencedaily.com­ /releases/2009/08/090804165151.htm
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These skulls, from victims of the Khmer Rouge, are on display in a Buddhist
stupa at Choeung Ek, a mass burial site commonly known as one of "the
killing fields." (Credit: Photo by Katie O'Brien, UNC School of Medicine)