Academic journal article Journal of Sociology

Perspectives on the Meanings of Symptoms among Cambodian Refugees

Academic journal article Journal of Sociology

Perspectives on the Meanings of Symptoms among Cambodian Refugees

Article excerpt

Introduction

The pre-migration experience of Cambodians in Australia has been one of turmoil, occasioned by the civil war, revolution and ongoing political instability that have characterized Cambodia since the 1960s. The period 1975 to 1979 was the time of greatest social upheaval and economic destruction, when cities were abandoned and the entire population undertook forced agricultural labour. Health and education systems were eliminated, religion abolished, the social structure was radically changed, and families were often summarily separated. Food deprivation, political indoctrination and organized terror were used to enforce submission to the regime, and physical violence, abuse and death became commonplace. It is estimated that between 1 and 2 million people died in that time. More than 21,000 Cambodians have migrated to Australia, and approximately 3000 settled in South Australia. The majority arrived as refugees in the period 1980-9, after prolonged periods in refugee camps, with little English, few possessions and minimal awareness of life in Australia.

Refugees have been identified as having a greater risk of mental ill-health than voluntary immigrants because of the pre-migration stresses they experience (Jayasuriya et al., 1992). Like other immigrants they face a period of adjustment on arrival in Australia, and low or lowered socio-economic status, employment difficulties, inability to speak the language of the host country, family separation, loneliness and isolation from people of a similar cultural background, as well as intergenerational conflict may contribute to an increased risk of mental ill-health at this time (Lin, 1986; Minas et al., 1996: 26; Stein, 1986). However, while exposure to stressors may elevate risk among vulnerable individuals, family integration, social supports, religious affiliation and personal coping styles may ameliorate their effect (Ager, 1993).

Background

In the western bio-medical paradigm, diseases are regarded as universal entities which result from injury or dysfunction, producing symptoms communicated as sets of complaints which transcend social and cultural context (Good, 1994: 8). Plural, competing and conflicting medical theories of body function exist and there are different explanatory models of what constitutes disease. In medical traditions such as the Indian and Chinese, alternative concepts of body function and dysfunction have been developed from those of the western bio-medical model (Obeyesekere, 1978, 1982, 1985; Tiquia, 1996; Tung, 1980; Wu, 1982). In these, well-being may be regarded as the result of a balanced relationship between the person and others, the person and nature, and the person and the supernatural (Good, 1994; Helman, 1990).

Kleinman (1980) has distinguished between two aspects of sickness: disease and illness. Disease is the biological and/or psychological process, while illness is the psychosocial experience of disease, which is shaped into behaviour. It is created by personal and cultural reactions to disease, and is largely a cultural construct (Kleinman, 1978). Good (1994) has argued culture is essential to the constitution of disease as a human reality, while Kleinman (1988) describes disease as what the medical practitioner creates in recasting illness in terms of theories of disorder.

Kleinman (1980, 1988) and Helman (1990) have suggested that culture influences whether external stimuli will be perceived as stressful or not, and whether bodily symptoms and emotional states are regarded as illness, or not. They are categorized, communicated, labelled and then ignored, denied or responded to according to culturally constructed explanatory models. Emotional states may not be displayed or directly expressed in some cultures and techniques for handling them vary from denial, displacement, projection and somatization (Kleinman, 1980; Shweder, 1985). Kleinman (1988: 57) defined somatization as `the communication of personal and interpersonal problems in a physical idiom of distress', and regarded the pattern of behaviour as one that emphasized the seeking of medical help. …

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