Baksbhat, or ‘broken courage,’ is a Cambodian idiom for emotional and mental distress that is often related to people’s traumatic experiences under the Khmer Rouge regime. This term is specifically used to talk about mental health in a cultural context where taboos and stigma often prevent an open discussion.
This kind of trauma isn’t just limited to those who lived through the Khmer Rouge. It can also manifest in younger people in the form of ‘generational trauma,’ which links the negative experiences of parents or grandparents to their children’s mental health.
In a Cambodianess article, Hoeur Sethul, president of the Cambodia Association for Counselors and Psychologists, noted that such trauma is likely one of the major causes of depression, anxiety disorder, and post-traumatic stress disorder (PTSD) among Cambodian youths, believing that it also contributes to the high suicide risk among teenagers.
Insufficient funding, lack of political will, limited solidarity from forefront stakeholders, and shortage of public mental health trainers makes it a hard task for the country to build a strong mental support system in the near future. In the meantime, the community could consider using available cultural resources and traditional practices such as Buddhist teachings.
Improving solidarity with forefront stakeholders such as health/mental health advocacy initiatives) and religious actors would be an effective solution to start decentralising the mental health support system.
Specifically, the principles of Buddhism may be considered a context-suitable and culturally aware vehicle for providing much needed mental and emotional support to all generations of Cambodians.
Impacts of limited resources
While the Ministry of Health acknowledged the high rates of mental disorders, the government’s overall investment in mental health services remains extremely low. Data shows only 2% of the budget for the Health Strategic Plan from 2016 to 2020 was spent on mental health.
In 2015, only 73 out of 102 referral hospitals and only 194 out of 1,141 health centres offered psychiatric consultations and primary mental health services. As of 2022, less than 10% of the Cambodian population has access to mental-health services and only 2% of the overall healthcare facilities nationwide offer mental health treatment.
This lack of effective mental health support was especially felt in the wake of the Covid-19 pandemic. The country is now facing alarming consequences.
Recent data from the Cambodian National Police also indicates that the suicide cases in Cambodia are increasing. It reveals that in the first quarter of 2022, the country saw 247 suicide attempts, 242 of which were successful. Five people survived with injuries.
The reality is without solutions that consider Cambodia’s cultural context, the struggle to tackle mental health will have economic implications on the populace. To increase their ability to work, a concerted effort between the Ministry of Public Health, private therapists, and Buddhist monks need to come together to help. Only with strong mental health support can the community achieve full economic inclusion and lifelong well-being.
To make this happen, Buddhist monks could teach meditation, testimonial therapy, embodied spirituality, and enteroception methods that could be applied to heal.
Culturally relevant mental health
While the ‘2016–2020 Health Strategic Plan’ by the Ministry of Health specifically mentions the need to develop services for mental health disorders and substance abuse, it doesn’t acknowledge the potential inclusion of religious stakeholders or practices in its initiatives. Neither has the public sector yet embarked on any activity that brings religious leaders to the table in a systemised way. Yet, key organisations active in this field have shown that incorporating culturally relevant religious practices could be highly beneficial.
As a result, some NGOs and private mental health consultants have been working to enhance and support mental health advocacy groups and institutions. Some include Cambodian Transcultural Psychosocial Organisation, (TPO), Sneha Centre, and Arom Station.
To reduce the gap between the need and the service provided, the Cambodian government, in cooperation with the Singapore International Volunteers, has launched a two-year project that aims to grow mental health care capacity in Cambodian hospitals. The outcome is expected to benefit around 30,000 people by 2024.
The local organisation TPO is especially active in promoting that spirituality plays a role in the mental health of their clients.
The group addresses local beliefs in their treatment process, combined with more standard tools like psychotherapy and medication. It uses mental health support tips and Buddhist ceremonies as a part of its counselling procedures, including rituals that acknowledge the death of loved ones.
As part of the population seeks traditional medicine treatments, Kru Khmer, or traditional healers, play a key role in the society, along with Buddhist monks, mediums, and fortune tellers.
A 2019 article, A pathway to mental health, showed the diversification and fruitful practice of merging western psychological and psychiatric methods with local traditions such as imam, medium, monks, and traditional healers. These practices together could offer an effective and culturally sensitive approach that seems to be in the best interest of mental health patients in Cambodia.
But there are more steps that the country could take to expand this combined approach, as well as more ways that Buddhism could play a key role in this process.
Trust in Buddhist traditions
As the major national religion, Buddhism has great potential to foster the trust of people in need of support while being wary of western conceptions of mental health. For centuries, Cambodian people have trusted Buddhist monks without questioning Buddhism practices.
The role of spiritual trust has been the subject of several academic research papers, one of which showed that Cambodian monks have been playing a crucial role in delivering mental health support to the local communities by assisting them in developing peace of mind and inner harmony.
This trust in religious leaders is not limited to negative or traumatic events. The community also invites monks on wedding days to give a water blessing or a chanting, similar to the Christian holy water blessing performed by a bishop. Local communities often turn to traditional healing methods and Buddhism also to seek prosperity and happiness, sometimes through wearing amulets and magic bands.
These rituals are believed to help people to recover from ‘broken courage’ and avoid unknown future danger, according to the article released in medical anthropology in 2013.
Monks often offer spiritual consultation and give advice to war veterans, as well as teenagers, elders, and new families. From 1978 to 1992, a monk named Maha Ghosananda worked with Cambodian refugees on the Thai-Cambodian frontier, helping meet their physical, moral and spiritual needs. He also established a walk for peace (Dhammayietra) along with other groups of monks from village to village to take care of sick people and preach Dharma on compassion, and community reconciliation.
Cambodia’s new generations also entrust ‘monk influencers’ who provide the community with advice based on Buddhist teaching. Thousands of people tune into video and audio podcasts of monks or dharma talk apps, and thousands more follow and consume social media content of influential monks such as Kou Sopheap, San Sochea, and Bhikkhu Kassapa.
A BBC report from June 2021 found that youth are inspired by the teachings of monk influencers like Venerable Kou Sopheap, and consider them as role models.
These monk-influencers have a strong capacity to connect old and young generations through social media platforms. This is likely the most effective way to reach out to the community nowadays, unlike in the past, when monks could only preach Dhama talk at ceremony events at the temple or at people’s houses.
Although Cambodia seems to be walking forward in incorporating Buddhism in mental health support practices, other Asian countries have previously attempted to connect the Buddhist teachings to mental health support programmes.
Bhutan has begun turning to Buddhism to play this kind of role since early 2018. The Bhutanese government passed a five-year action plan from 2018 to 2023 on suicide prevention in the country, which aims to call religious actors to collaborate with public institutions to address mental health issues. .
On the same line, Cambodia should use the available resources to address the mental health needs of its citizens. Buddhism, together with more common mental health support practices, has the potential to play a life-changing role in thousands of Cambodians who are struggling with mental health issues or trauma. It would be the key for addressing these issues and improving the future well-being of the country.
[Chea Sameang is a former freelancer at Kiripost and is now a junior research fellow at Future Forum, an independent think tank generating new thinking for a new Cambodia.]