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Cambodians’ Vision Loss Linked to War Trauma

The Los Angeles Times, Oct. 15, 1989


Scores of Cambodians complain they are blind or suffer blurry vision although their eyes are normal–a malady some experts blame on the horrors they witnessed in the killing fields of their native land.


“These women saw things that their minds just could not accept,” said psychology professor Patricia Rozee-Koker of Cal State Long Beach, who studies vision complaints of the Khmer Rouge regime’s refugees.


“Seventy percent of the women had their immediate family killed before their eyes,” she said. “So their minds simply closed down, and they refused to see anymore–refused to see any more death, any more torture, any more rape, any more starvation.”


The majority of the refugees with vision complaints are 40- to 70-year-old women who fled the Khmer Rouge regime, which was toppled a decade ago.


Experts believe that the refugees suffer hysterical, psychosomatic or functional blindness, in which psychological turmoil spurs people with normal eyes to believe that they are blind or see poorly.


Many of the Cambodians also show signs of severe depression and post-traumatic stress disorder, which afflicted many Vietnam War veterans, Rozee-Koker said.


Eye doctors said it is very difficult to distinguish patients with hysterical vision loss from malingerers who fake blindness to obtain disability benefits, attention or sympathy.


Some question whether psychological vision problems were triggered by sights of mass murder of Cambodia, or by trauma endured by Khmer-speaking Cambodian peasants adjusting to U.S. life.


“I think it’s a real phenomenon,” said Dr. Hector Sulit, a Long Beach eye doctor who examined dozens of Cambodians in recent years. ”It could be the trauma; The other possibility is cultural shock. There might be a few looking for sympathy.”


Dr. Michael F. Marmor, ophthalmology chairman at Stanford University School of Medicine, said Cambodians examined there “for the most part were not consciously malingering, although it’s almost impossible to rule out.”


Hundreds of thousands of Cambodians were killed from 1975 to 1978 by Pol Pot’s fanatical communist Khmer Rouge, who tried to transform the nation into an agrarian commune until Vietnam invaded in late 1978. Nearly 200,000 Cambodians fled to the United States. Vietnam withdrew its troops in September.


Hysterical blindness has been reported among shell-shocked soldiers during World War I, children of divorced parents and people involved in traffic accidents.


Five years ago, an unusual number of female Cambodian refugees with psychosomatic vision problems were noticed by Gretchen Van Boemel, an electrophysiologist at Doheny Eye Institute in Los Angeles.


She contacted Rozee-Koker, an old friend, and since then they identified about 150

Cambodian refugees in Long Beach who claim blindness or blurred vision, although brain wave and eye tests find nothing physically wrong.


“One woman saw her four children and husband killed in front of her, then lost her vision right after,” Van Boemel said. “One woman watched her husband and three children taken away in 1975. They never returned. She reported she cried daily for four years, then she stopped crying and couldn’t see.”


About 15% of the women said they were blind–with no perception of light–and the rest claimed varying degrees of blurry vision, she added.


At Stanford, Marmor and Dr. Michael Drinnan examined a number of people with psychosomatic blindness during the last two years.


“There were more Southeast Asians with functional vision loss than other members of society, and almost all seem to be Cambodians,” a majority of them women, Marmor said. “Most had some perception of light, but they ranged widely over what they could see. We speculated this may have to do with war trauma.”


Rozee-Koker and Van Boemel initially interviewed 30 Cambodian women through an interpreter, and found that those with the worst vision spent the most time living under the Khmer Rouge or in refugee camps.


“The women’s trauma history was extreme,” Rozee-Koker said. “They had lost several to all of their relatives. They experienced beatings, starvation, forced labor, humiliations, separation from their families.” She also suspects that the women may have been raped.


Dr. Eric Nelson, an ophthalmology fellow at UCLA’s Jules Stein Eye Institute, said the women’s psychosomatic vision problems “did seem to happen shortly after they saw some horrendous things, but they also went through horrendous changes of life” as refugees.


Marmor speculated that Cambodian refugees may be more prone to complain of vision trouble because they tend to be uneducated peasants who experience difficulty adapting to life in a new country.


“To know whether the Cambodian war was the cause of this would really take some scientific scrutiny, particularly when we have such a different social situation and culture to understand,” said Dr. John Keltner, ophthalmology chairman at UC Davis.


Since 1977, Keltner and colleagues examined 137 patients who complained of vision problems but had healthy eyes. They included Laotian refugees but not Cambodians. Most were faking to obtain disability payments or awards in lawsuits, Keltner said.


Nelson studied eight Cambodians to determine if their vision complaints were sincere.


“Some had applied for disability, but some months before their vision loss,” he said. “In five cases, the patients were given a diagnosis of major depression,” and two more also probably suffered from it.


Van Boemel said most of the women she studied also had psychosomatic headaches, dizziness, general malaise and stomach cramps.


Rozee-Koker said the women sit isolated in their rooms and live over and over the trauma through horrible nightmares and intrusive thoughts,’ and their vision problems are worse when they feel depressed.


Two years ago, Van Boemel and Rozee-Koker placed five of the women in group psychotherapy, while five others participated in a group where they learned survival skills: how to call police, shop and ride buses.


After 10 weekly sessions, about three-fifths of the women reported improved vision and reduced depression, Rozee-Koker said.



Cambodian Witnesses to Horror Cannot See

The New York Times, Sept. 8, 1989

Alexandria Smith


Long Beach, CA: One Cambodian woman saw Khmer Rouge soldiers tie up her parents, cut their throats and throw them into a river. Another saw her child bashed to death against a tree.


Ten years later, in Long Beach, Calif., the eyes that witnessed these horrors cannot see.

These women and dozens of others here in the largest Cambodian community in the United States have problems with their vision that keep them in their homes, in some cases unable to care for themselves.


But sophisticated brain wave tests show that they should have perfect, 20/20 eyesight. Doctors and specialists say that there is no physical explanation and that what they have is functional blindness, a vision loss caused by psychological factors.


“They just don’t want to see anymore,” said Gretchen Van Boemel, an electrophysiologist at the Doheny Eye Institute in Los Angeles.


Five years ago Ms. Van Boemel, who is writing her doctoral dissertation on the subject, noticed that many patients with unexplained vision loss were middle-aged Cambodian women with strikingly similar backgrounds.


While functional blindness is a known psychological disorder, there has been virtually no documentation of the condition in specific population groups.


In her seven and a half years at the Doheny Institute, Ms. Van Boemel has seen only three American-born patients with the condition. More than 50 years of research has turned up 30 reported cases nationwide, she said. She has identified at least 150 Cambodian women with unexplained vision loss in Southern California.


“I kept seeing women from Cambodia that came to me with basically the same ocular history,” she said. “Usually it was something like, they saw their husbands murdered in front of them and cried and cried and when they stopped crying they couldn’t see.”


She said all lost their vision sometime after Pol Pot became prime minister of Cambodia.


More than a million Cambodians were executed or died of starvation under his Communist

Government, which lasted from 1975 until the 1978 invasion of Cambodia by the Vietnamese, in which he and the Khmer Rouge were ousted; millions more Cambodians were slave laborers. About 179,000 Cambodian refugees now live in the United States.


Ms. Van Boemel joined with Patricia Rosee-Koker, a professor of psychology at California

State University-Long Beach, to study 30 of the more than 150 Cambodians Ms. RoseeKoker had found functionally blind.


Their responses to a questionnaire determined that almost all the women, 51 to 70 years of age, were constantly depressed. All had starved and spent five to eleven and a half in refugee camps and forced labor camps. Many told Ms. Van Boemel that their vision began going shortly after they saw a traumatic event.


“I was working in the rice fields when the Communists attacked,” said Chhean Im, now 61, who lives in Long Beach with her teen-age daughter and nephew. “They were chasing and shooting people so I ran and hid in the jungle.”


Mrs. Im, the widow of a Cambodian Army soldier, stayed in the jungle three days. “I was just crying, crying, crying and when I stopped crying my eyes were swollen and I couldn’t see,” she said.


For the next four years, she said, she worked under slave-like conditions, carrying buckets of water from early morning until dusk. She watched as her three youngest children starved to death. Her eyesight today should be excellent, but she sees only blurred shadows.


The researchers sampled only women: they found few Cambodian men who had the affliction, possibly because more men than women died under the Pol Pot regime.


“Our main finding,” Dr. Rozee-Koker said, “was that the longer the time spent in the camps, the worse their psychological condition in terms of psychosomatic blindness.


“It’s almost like a see-no-evil kind of thing.”


When she and Ms. Van Boemel began their research, the scientific literature involved offered up only one other study of psychosomatic blindness in a specific population group: World War I veterans in England, Dr. Rosee-Koker said anecdotal evidence suggests a significant rate of functional blindness among survivors of the Holocaust and Vietnam War veterans.


The researchers are convinced that intensive therapy would improve the women’s eyesight.


Mrs. Im said, “When I’m scared, I don’t see well and get headaches. When I feel better, I can see better.”


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