DO YOU HAVE ‘BAKSBAT’ INSTEAD OF PTSD? HMM…MAYBE. ‘BAKSBAT’. INTERESTING.

Contrary to popular belief, traumatic stress does not automatically mean you will suffer from what would be called ‘post-traumatic stress disorder’. The shock of trauma can evoke many kinds of reactions. My recent work in Cambodia taught me this new term: “BAKSBAT”, which translates into English as “BROKEN COURAGE” or ‘double-fear’.

As a child who lived through the horrors of the post-Vietnam era’s Khmer Rouge Killing Fields, Cambodian psychiatrist Sotheara Chhim notes only 2-3% of the impacted population in post-conflict Cambodia would meet the diagnostic definition of PTSD. Instead of PTSD, a significant number of Cambodians survivors who were truly impacted suffer from something different — what was called ‘broken courage’ … ‘baksbat’. This led him to suggest post traumatic stress (PTSD) may be a Western response to trauma rather than a universal response. Baksbat, which has been defined as a Cambodian ‘cultural syndrome‘, is expanding our understanding about reactions to trauma – and recovery approaches. In his article on the subject, Dr. Chhim says, “Baksbat appears to be an idiom of distress with some degree of overlap with post-traumatic stress disorder (PTSD), anxiety, depression, and or dissociative features, but further research is required to flesh this out.”

Let’s examine this more so we can understand it,

image credit: Free Image on Pixabay – 239667pixabay.com

Symptoms of broken courage are psycho-physiological, psycho-social and psycho-spiritual. Take a look at the 24-item self-report “Baksbat. Broken Courage Inventory” below. It is divided into three experiential clusters:
1) psychological symptoms,
2) cultural symptoms of ‘broken courage’ and
3) erosion of Self

Chhim found baksbat was a reaction to coping with “a traumatic shock from which there is no escape”.

Frankly, I believe ‘broken courage’ is a good description of what many are dealing with after 3 plus years of pandemic isolation, coping with an onslaught of “shocking losses from which there was no escape”: interpersonal and societal conflicts, economic loss and continued uncertainties, along with political anxieties and violent global crises. Even as COVID Crises begin to unwind, many of us continue to live in a sad, economically unpredictable and violent world while also coping with floods, hurricanes, earthquakes and firestorms.

In Cambodia baksbat triggers can range from the sudden loss of a loved one, to combat shock, to a landmine accident, to being frightened by spirits or ghosts, to being chased by wild animals. Healing includes: medical interventions and medication if needed; psycho-social interventions; judicial and community testimonials; spiritual interventions, like Buddhist ceremony for deceased ancestors robbed of this sacred community tradition; compassion; and forgiveness for both survivors and Khmer Rouge perpetrators of genocide.

Confirming the importance of culture is interesting. It reminds us how mental health is multifaceted and includes:
~soothing the soul spiritually;
~tending to physical needs materially;
~caring for ‘psycho-social’ emotional needs, (which includes a need for justice); and,
~changing one’s actions, ideas, and beliefs
in relationship to oneself, others, and the world around us.

Taking the latest pharmaceuticals paired with cognitive – behavioural – management – of – symptoms is not enough to fully restore one’s innate courageous creative spirit, joi de vivre, and inner peace.

If our response to trauma is, in part, culturally defined, then best treatment strategies would be integrated into Western psychology’s protocols – those tried-and-true cultural healing practices and folk-medicine traditions used by non-Western cultures before colonization. The capacity to build genuine culturally integrative trauma recovery protocols hinges on acknowledging and ending the viral spread of a consumer-culture that extends the reach of modern Western European / American influence. While it may offer some benefits (like financing roads, bridges, water filtration systems and hospitals for example) it also promotes social, political and economic conflict, cultural genocide, and justification for going to war, which ends in massive trauma and millions of lives lost. Naming our complex response to all this turmoil from which there appears to be no escape as ‘broken courage’ makes sense to me. What about you?

SO, HOW DO WE REPAIR BROKEN COURAGE AND RESTORE OUR COURAGEOUS CREATIVE SPIRIT?

In my next few blog posts I will share some of the Cambodian physical, mental, emotional and spiritual self-care approaches, as described by Cambodian colleagues who completed my CITIS two-day series of workshops in Phnom Penh. It is with their permission that I share, for educational purposes, what I learned from them, so all of us may learn and grow together. Many key staff of the Community Mental Health Hospital, under the direction of Dr. Chhim, operated by the Trans-cultural Psycho-social Organization-Cambodia (TPO) were in attendance at the program and had much to share as we explored burnout prevention, compassion fatigue, responding to survivor’s guilt and recovery from ongoing multi-generational post-Vietnam war trauma that continues to burden the Cambodian population.

This program was the dream-child of sponsors from the Angkor Institute of Consciousness (AIC) and the Canadian Institute for Transpersonal and Integrative Sciences (CITIS). I have immense gratitude and appreciation for all those collaborators who helped make this program possible including: AIC’s Director Dr. Julie Bonitha Svay, Harold Finkleman, CITIS Co-Chair; and TPO’s Director Dr. Sotheara Chhim, along with TPO staff and participants.

© February 17, 2023. Permission to reprint for educational purposes is granted by Dr. Beth Hedva and Harold Finkleman, CITIS.