Echoes of the Holocaust
Shalom Robinson, M.D., Editor

Contents
Holocaust Survivors and Survivors of the Cambodian Tragedy: Similarities and Differences*

Dan Savin, M.D. 1 and Shalom Robinson, M.D. 2, 3

Introduction
After the Second World War, when names such as Auschwitz, Sobibor, Treblinka and the dimensions of the destruction of the Jewish people became known to the world, many wrote and said that after the Shoah there could be no other genocides. The nations, it was claimed, would not allow such a thing to happen again.

Since then, however, international conflicts between rival ideologies have caused many wars with millions of victims. The Cambodian conflict and the Khmer Rouge regime headed by Pol Pot caused a catastrophe for Cambodia and a shocking number of victims.

The idea of comparing Holocaust survivors to other ethnic groups who suffered severe persecution, with a different history and a different social, religious, and cultural background, has intrigued me for some time (S.R.). The opportunity to carry out such a comparison arose when I met Dr. Dan Savin, who already had research experience in Cambodia and planned to return there.

The first author (D.S.) feels that the suffering of his grandparents in Europe before the Holocaust motivated his wish to help survivors in Cambodia, where he accepted a job as psychiatrist, then as a general physician, from 1991 till 1994. Such motivation can be understood through Flora Hogman's article. (11)

In June 1996 during a trip to Cambodia, D.S. interviewed 14 subjects, mainly young adults who had been children or teenagers during the Pol Pot regime. Some were from the city, but most, better reflecting the demography of Cambodia, were from the countryside. About half of the interviewees had been refugees who returned to the country from camps at the Thai-Cambodian border in 1993 during the UN-sponsored repatriation; the other half had never left Cambodia. Interviews were carried out in Khmer, a language in which D.S. was conversant. An attempt was made to summarize some of the experiences these people went through before, during, and after the Pol Pot regime. Questions were asked pertaining to current psychiatric symptoms, especially those necessary to make a DSM-IV diagnosis of posttraumatic stress disorder (PTSD) or depression.

In this paper, we describe the histories of six fairly typical survivors of the Cambodian tragedy. We compare the psychosocial effects in these survivors almost 20 years later to those of Holocaust survivors 50 years after the Shoah. We also attempt to suggest how each society has been influenced by and reacted to the trauma.

Interviewsa

Paula
Paula is a 34-year-old female who lives in a resettlement center in Western Cambodia. She repatriated from Site II refugee camp in Thailand in 1993 along with her husband and five children. She and her husband have a small business selling rice porridge every morning several miles away in Battambang city. Two of her children are attending school, and the others have not yet started.

Before Pol Pot came to power, her father was a mid-ranking officer with the Lon Nol government. She was living with her grandmother who had taken a special liking to her. Grandmother lived in western Cambodia, while her mother and six siblings lived in the east. She recalls that the family was well-off enough that every two or three months she was able to fly to visit the rest of them. She remembers that for several months before the Khmer Rouge came to power there was much shooting and shelling, and that shortly after they assumed power many people were taken off to be killed.

The first year of the regime was not as bad for her as later on because she was still allowed to live and eat with her grandmother. After one year, she was transferred to a work group with other teenagers and soon everyone ate together in one large room. She worked very hard in the rice fields, and was hungry most of the time. On one occasion she was caught stealing some raw corn from the field. Her punishment was a severe beating, including being hit on the head with a stick. She was warned that if she was caught again she would be killed, and remembers that a number of children were actually killed because they took extra food.

On one occasion, she recalls going to the hospital when she was sick with diarrhea. She observed that the Khmer Rouge cadres were giving injections that killed the patients. She pleaded with one of the hospital staff, who pitied her and gave her an injection of coconut milk rather than poison.

Paula said that anybody who had gone to school and appeared educated was beaten or killed. She witnessed many people being hanged or beaten to death during the Khmer Rouge regime. As the 1979 Vietnamese invasion progressed and it became evident that the Khmer Rouge were going to be ousted, they slaughtered many more people.

After the Vietnamese won the war, she went back to her grandmother's village and she and her grandmother were reunited. She learned that her mother and father as well as her five brothers had been executed because their father had served in the Lon Nol army. Because she had no way of making a living in the village and because she had heard that foreigners were giving out food in the refugee camps at the border with Thailand, she decided to go there. She spent ten years in the camps, where she says that though she did not go hungry, it was very difficult for her to operate a business because of the restrictions imposed by the Thai authorities. She remembers many occasions when Thai soldiers beat Khmer people.

Paula says that for the most part life now is better for her than it was in the refugee camp, because she has the freedom to go wherever she wants and is able to make a meager living from her and her husband's small business. She reports, however, that she feels sad most of the day almost every day. She says that she does not really enjoy doing anything and thinks daily about her family members who were killed; that her appetite is poor and she has difficulty sleeping at night. She denies feeling excessive guilt over anything that happened to her and does not have difficulty concentrating or making decisions. She complains of being constantly tired but is able to run her business and take care of her home. She has frequently thought that she would rather be dead, but would never do anything to harm herself because of her children. The author was able to observe her interact with her children in a cheerful manner.

Paula continues to think frequently about the time of Pol Pot and has difficulty putting these thoughts out of her mind. She has recurrent nightmares of bodies hanging from trees and of the time she was beaten for taking extra food. She becomes upset when she hears or sees things which remind her of Pol Pot times, such as hearing news about the Khmer Rouge on the radio or the sound of shelling in the distance. She does not think the future holds anything special for her, but hopes that her children will be able to study and to have a good future. She denies having any difficulty getting close to people, as evidenced by her relationships with her children. Paula is easily startled by loud noises such as dogs barking and reports that she is easily angered by unimportant matters. [Page 1 of 7]

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* The authors thank Prof. Y. Gutman for his comments. We thank Sylvia Iwrey, Dr. Wendy Freed, Joseph Savin, and Chanrithy Him for their assistance.
1. Daniel Savin, M.D. 6737 E. 5th Ave., Denver, CO 80220, USA.
2. Center for Research Into the Late Effects of the Holocaust.
3. Sarah Herzog Memorial Hospital, affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel.

a The names of the interviewees are fictitious.

Bibliography
11. Hogman, F. Memory of the Holocaust. Echoes of the Holocaust, 4:36-49, 1995.