Phnom Penh (Cambodia) February 5th 2009: Richard Rechtman, psychiatrist, and Soko Phay Vakalis at the Bophana Center workshop for visual artists.
©John Vink/ Magnum
Ka-set
By Stéphanie Gée
06-02-2009
Richard Rechtman never imagined he would be spending so much time working with Cambodian refugees living in France. The psychiatrist, who also happens to be an anthropologist, is medical director of the Institut Marcel Rivière, a researcher at the Interdisciplinary Research Institute on Social Issues (IRIS) Institute of the EHESS (Ecole des Hautes Etudes en Sciences Sociales) in Paris and editor-in-chief of the French magazine l'Évolution Psychiatrique. Since 1986, he has been listening to, healing, curing and leading researches on the Cambodian diaspora living on the French territory, a community now composed of some 40,000 beings. He set foot for the first time on the Cambodian territory after accepting an invitation to work on creation workshops organised in Phnom Penh by the Bophana Audiovisual Resource Centre. In a two-part interview by Ka-set, he goes back over his experience and career, his approach as a professional and man with a cause as well as his views and theories.
Ka-set : As early as 1986, you started working with Cambodian refugees living in France. Why did you wait 22 years before coming to Cambodia?
Richard Rechtman : First of all, I always wanted to specialise in the question of exile and social disparity linked with exile. Even before working with Cambodians, I took an interest in asylum seekers, political refugees and immigrants too.
It was an era when humanitarian medicine and psychiatry were starting to gain media coverage and people won much acclaim in going abroad for three days to give examinations and then come back saying 'I was there'... I didn't want to do that […] but rather wanted to carry out regular work within a community which resettled in France, with all the complexities that exist in acculturation, etc. My main interest was not Cambodia but Cambodians in France. Now that I have come here, I realise there are many things I would have understood earlier if I had come here, it's obvious. But I also think there are many things I would not have been able to see had I come earlier, especially regarding the specificity of culture transplantation and the specificity of views about the past, and mainly the dead. I wouldn't have been able to interpret them like I have done, because there was this need to be immersed in these two cultures.
This is when I understood that Cambodian refugees did not think about the dead but that they were overwhelmed by their dead. They are not in a process of remembrance... It's a physical, psychological invasion and an everyday presence. And I think that I was able to understand that in France thanks to this discrepancy, but also because there was this certain exteriority as to the place they came from. You're going to tell me that these are mere rationalisations – maybe there were other reasons... But in any case, I didn't miss it, and I didn't want to come here as a tourist.
K7 : So what made you make your mind up and come here?
RR : Two reasons for that. First, my fondness for Rithy Panh [filmmaker and co-founder of the Bophana Centre] who once told me: 'One day, I'll take you to Cambodia!'. [laughs] And then, the Bophana Centre offered me to do something I couldn't refuse: they offered me to meet, and work with Vann Nath [a painter, who survived S-21]!
Then, a year ago, I was asked to help a team of psychologists at the PSE [Pour un Sourire d'Enfant] organisation. I made a rather crazy suggestion: holding an internet supervision every fortnight - and it's going really well! During my biweekly Cambodian consultation, I communicate with them for an hour on Skype and they talk to me about their patients. […] Conditions, it's true, are complicated: an average connection, we have to speak English, which I wanted – having no in-between interpreter in order to be on an equal footing when it comes to language difficulty; it creates bonds. I wanted to come and meet them.
K7 : How did you end up working with Cambodian refugees?
RR : First, I worked in the only transit centre, in Créteil, which welcomed all refugees coming from Southeast Asia to France. And the question was raised as to the opening of a psychiatric centre, since these people come with very big problems. Back then, nobody worked on Southeast Asia as a psychiatrist, so they asked me as I also studied ethnology and started to take an interest in that region of the world. I was a beginner in my ethnology and psychiatry course, and I accepted that consultation. I saw a great deal of Cambodians coming and going, many mentally ill people too.
Later, countries like France accepted refugees who had stayed in refugee camps for a long time and had serious mental disorders... Quite frankly, I didn't see that as a good idea. Transplanting schizophrenic persons like that, into a foreign country, when they don't know the language and will have no friends there... It meant sending them straight to a psychiatric hospital – in a foreign country! I was very concerned and made a report on that, which wasn't followed at the time. I was rather young, it was only normal...
When I finished my internship, I wanted to create a Cambodian consultation in a free health centre – I wanted it to be public psychiatry, for free, in the places where there were many Asians, i.e. in the 13th arrondissement of Paris. We created something very original. We had three interpreters (in Khmer, Vietnamese and Lao languages) but very rapidly, it turned out that among our patients, there were many more Cambodians, whom I was more importantly interested in, intellectually speaking.
[…] I was very lucky because the director of that hospital helped me a great deal and gave me the ability to work. This is how the project was built. Afterwards, it expanded since in the meantime I was leading an investigation among the Cambodian community, to know how it managed to rebuild itself; the professor who supervised my Master's dissertation in ethnology, Charles Meyer, opened for me all doors to the community living in France. […] And then, a network of people started sending me patients.
When I met Cambodians, at the pagoda for instance, they told me: 'You know, there are no mentally ill people among us, this is a European construct'. One day, at the pagoda, a guy, whom I'd bumped into several times and who kept repeating to me that there were no mentally ill people in their community, told me: 'By the way, are you a psychiatrist? Are you seeing patients? I know someone – he is not mentally ill – but it would be good if you could see him!' I thought nobody in the community would send me patients, considering how coy they were when it came to mentally ill people. But then, saying that they were not mentally ill and that they came to see me because I was nice and I showed an interest in Cambodians was enough – my number of patients shot up. This completely changed the deal, and I was given the ability to be very much part of the Cambodian community, not as a member, but as someone who did a considerable favour, in the sense that they could send me people. And I said that there were no crazy people.
K7 : Did your status of foreigner help you in that job?
RR : Absolutely. I remember a patient, a woman, who faced terrible family disputes and most of all, you could sense her personal story was affected by sexuality. She clammed up and told me: 'You do know that in my country we don't talk about those things'. I replied that I did and that it was precisely the reason why she had come to see me. It made her laugh and she started talking. The role of a medical practitioner is also to be able to breach certain rules. Is is also to be able to do what we do not speak. The idea that in a culture you don't talk about particular things doesn't mean you don't think about them. That's all the work I have been trying to do.
K7 : Could go back over the attachment that survivors of the Khmer Rouge regime showed towards their dead and which you observed?
RR : What took me a long time to understand is the fact that there was a presence of the dead which was very overwhelming. Here is a little clinical 'action replay' for you to understand how I became aware of that:
A young Cambodian woman, seen by everyone as gifted, was sent to me by her mother. She had gone through a breakdown before taking her baccalaureate, which she failed, and started suffering from mental anorexia. She was very poorly. Her father was dead. I struggled to get anywhere with that young woman's case so one day, I thought about meeting her with her mother. The mother was desperate because all hope of success had vanished and to her, her daughter would never reach the level she expected – and she had come to France precisely for that purpose. I was slightly intrusive and asked where she was during Pol Pot's regime. The daughter looked at her mother and said: 'Who is Pol Pot?' She had never heard about him! I asked the mother: 'Did you never mention it to her?' 'No, never.' 'Why?' 'Why, because they're all dead!' The daughter then said: 'Oh, I know that, that all my family have died!' I asked her if she had any idea who they were and she said 'no, they're dead!'. It was the first time I heard that: 'they are dead'. The state of being dead – and nothing before that. The mother could not say anything else than 'they are dead'.
This is when I started transforming my job a little. 'But before being dead, what were they?' The mother was taken aback by the question. I continued: 'Because they surely lived, before...!' And I told the daughter: 'The way they died is not your business but before they died is indeed your business. Why don't you question your mother?' Then, all at once, the mother started talking about her father, with whom she had very strong bonds. She explained that he wanted her to go and study, but the plan did not go that far because of the arrival of the Khmer Rouge... It is not the trauma, but what could not be said about another story.
When we honour our dead, we should say we honour our living, who are not any more: we keep a bond there, it is a metaphor. We do not think about them as corpses. I became aware that all my Cambodian patients only talked about one thing, the dead, who are everywhere - which is not the case of the ghosts we encounter in very separate mental worlds, where all sense of reality and real life disappears. […] Then, I went to enquire about the Khmer Rouge propaganda, what they had done... Not about the technical nature of it but about the intention of genocide. Some great texts, like the one written by Primo Levi, recount this attempt of dehumanisation. After that, I read survivors' stories, which had been published, but they were told and addressed in a certain way and you can feel it while reading them. There is almost compassion in the way the narrative is related. I understood that people are always asked to recount stories for the dead. This is why I decided, in the same way that an archaeologist would act, to look for traces of an intention of genocide, from what we see in the consequences this had on psyche, of course, and on society in general. For the dead to be just the dead: this, in my view, is almost the evidence of an intention of genocide. [...] It is impossible to imagine a society without funeral rites, a society which does not honour its dead, and this is what makes us human beings, even in the worst of situations! [...] And the Khmer Rouge tried to destroy that bond between the dead and the living, to annihilate people. The first step of that was to destroy the dead, then kill death, kill the living, and then cut off all social bonds... for beings to find themselves all alone while in the meantime, they keep being told that they must be the element among an unknown multitude, which is not based on networks of solidarity but on the obligation of being multiple...
Finally, the use of death not as a threat. As an anthropologist, I compared this with war crimes. War crimes are synonymous with demonstration. For instance, the mutilation of bodies during the Algerian War. Why? For the person who passes by next can see it! There, in the case of the Khmer Rouge, it's nothing like that! People do not know when executions are going to be carried out, people do not know where the bodies are. Death is not used to terrorise but to be identified with the living. The dead and the living find themselves in the same space. And if Jacques Vergès can say it is the mistake of a small administration and that it is no intention of genocide, he will have to prove why it was done. [...] For every individual, it is not so easy to kill another human being. The Khmer Rouge solved that riddle, you only have to create conditions such that the person you kill is not a human being. And here, you have the framework of the whole genocide. Killing becomes easy, people don't have to be perverts or bastards to do it and they don't even have a guilty conscience afterwards.
K7 : In your job, you do not put much emphasis on trauma...
RR : Yes, for several reasons. I wrote a book with Didier Fassin – The Empire of Trauma: An Enquiry into the Condition of Victimhood [Princeton University Press, due for release in English May 2009], which is not criticism of the trauma, far from it, but a vast deconstruction of the social and contemporary uses of trauma. [...] I reckon that mental health goes far beyond trauma and that focusing on it means taking the risk of sometimes letting many other forms of expression pass us by, whether they be linked or not to that period of suffering.
Trauma is given more importance than necessary, and especially importance of a moral nature. We say: we have to mend these people because they are traumatised. No! We do not mend these people because they are traumatised but because what was done to them is unbearable, unacceptable, intolerable. It is injustice, whether they were traumatised or not. But today, it is one of my greatest fears, we are coming to legitimise a political action in the name of the fact that people suffer psychologically within their soul. But does this mean that if they do not suffer, they can stand and bear everything? Some do not suffer psychologically because of social injustice. But should we just leave them like that? As a psychiatrist, I heal people who suffer, and as a man involved in political action, this categorisation disappears, as far as I am concerned, and I think about the people in need... I am quite hostile to categorisations... [laughs]
The second part of this interview will be published on Monday February 9th.
By Stéphanie Gée
06-02-2009
Richard Rechtman never imagined he would be spending so much time working with Cambodian refugees living in France. The psychiatrist, who also happens to be an anthropologist, is medical director of the Institut Marcel Rivière, a researcher at the Interdisciplinary Research Institute on Social Issues (IRIS) Institute of the EHESS (Ecole des Hautes Etudes en Sciences Sociales) in Paris and editor-in-chief of the French magazine l'Évolution Psychiatrique. Since 1986, he has been listening to, healing, curing and leading researches on the Cambodian diaspora living on the French territory, a community now composed of some 40,000 beings. He set foot for the first time on the Cambodian territory after accepting an invitation to work on creation workshops organised in Phnom Penh by the Bophana Audiovisual Resource Centre. In a two-part interview by Ka-set, he goes back over his experience and career, his approach as a professional and man with a cause as well as his views and theories.
Ka-set : As early as 1986, you started working with Cambodian refugees living in France. Why did you wait 22 years before coming to Cambodia?
Richard Rechtman : First of all, I always wanted to specialise in the question of exile and social disparity linked with exile. Even before working with Cambodians, I took an interest in asylum seekers, political refugees and immigrants too.
It was an era when humanitarian medicine and psychiatry were starting to gain media coverage and people won much acclaim in going abroad for three days to give examinations and then come back saying 'I was there'... I didn't want to do that […] but rather wanted to carry out regular work within a community which resettled in France, with all the complexities that exist in acculturation, etc. My main interest was not Cambodia but Cambodians in France. Now that I have come here, I realise there are many things I would have understood earlier if I had come here, it's obvious. But I also think there are many things I would not have been able to see had I come earlier, especially regarding the specificity of culture transplantation and the specificity of views about the past, and mainly the dead. I wouldn't have been able to interpret them like I have done, because there was this need to be immersed in these two cultures.
This is when I understood that Cambodian refugees did not think about the dead but that they were overwhelmed by their dead. They are not in a process of remembrance... It's a physical, psychological invasion and an everyday presence. And I think that I was able to understand that in France thanks to this discrepancy, but also because there was this certain exteriority as to the place they came from. You're going to tell me that these are mere rationalisations – maybe there were other reasons... But in any case, I didn't miss it, and I didn't want to come here as a tourist.
K7 : So what made you make your mind up and come here?
RR : Two reasons for that. First, my fondness for Rithy Panh [filmmaker and co-founder of the Bophana Centre] who once told me: 'One day, I'll take you to Cambodia!'. [laughs] And then, the Bophana Centre offered me to do something I couldn't refuse: they offered me to meet, and work with Vann Nath [a painter, who survived S-21]!
Then, a year ago, I was asked to help a team of psychologists at the PSE [Pour un Sourire d'Enfant] organisation. I made a rather crazy suggestion: holding an internet supervision every fortnight - and it's going really well! During my biweekly Cambodian consultation, I communicate with them for an hour on Skype and they talk to me about their patients. […] Conditions, it's true, are complicated: an average connection, we have to speak English, which I wanted – having no in-between interpreter in order to be on an equal footing when it comes to language difficulty; it creates bonds. I wanted to come and meet them.
K7 : How did you end up working with Cambodian refugees?
RR : First, I worked in the only transit centre, in Créteil, which welcomed all refugees coming from Southeast Asia to France. And the question was raised as to the opening of a psychiatric centre, since these people come with very big problems. Back then, nobody worked on Southeast Asia as a psychiatrist, so they asked me as I also studied ethnology and started to take an interest in that region of the world. I was a beginner in my ethnology and psychiatry course, and I accepted that consultation. I saw a great deal of Cambodians coming and going, many mentally ill people too.
Later, countries like France accepted refugees who had stayed in refugee camps for a long time and had serious mental disorders... Quite frankly, I didn't see that as a good idea. Transplanting schizophrenic persons like that, into a foreign country, when they don't know the language and will have no friends there... It meant sending them straight to a psychiatric hospital – in a foreign country! I was very concerned and made a report on that, which wasn't followed at the time. I was rather young, it was only normal...
When I finished my internship, I wanted to create a Cambodian consultation in a free health centre – I wanted it to be public psychiatry, for free, in the places where there were many Asians, i.e. in the 13th arrondissement of Paris. We created something very original. We had three interpreters (in Khmer, Vietnamese and Lao languages) but very rapidly, it turned out that among our patients, there were many more Cambodians, whom I was more importantly interested in, intellectually speaking.
[…] I was very lucky because the director of that hospital helped me a great deal and gave me the ability to work. This is how the project was built. Afterwards, it expanded since in the meantime I was leading an investigation among the Cambodian community, to know how it managed to rebuild itself; the professor who supervised my Master's dissertation in ethnology, Charles Meyer, opened for me all doors to the community living in France. […] And then, a network of people started sending me patients.
When I met Cambodians, at the pagoda for instance, they told me: 'You know, there are no mentally ill people among us, this is a European construct'. One day, at the pagoda, a guy, whom I'd bumped into several times and who kept repeating to me that there were no mentally ill people in their community, told me: 'By the way, are you a psychiatrist? Are you seeing patients? I know someone – he is not mentally ill – but it would be good if you could see him!' I thought nobody in the community would send me patients, considering how coy they were when it came to mentally ill people. But then, saying that they were not mentally ill and that they came to see me because I was nice and I showed an interest in Cambodians was enough – my number of patients shot up. This completely changed the deal, and I was given the ability to be very much part of the Cambodian community, not as a member, but as someone who did a considerable favour, in the sense that they could send me people. And I said that there were no crazy people.
K7 : Did your status of foreigner help you in that job?
RR : Absolutely. I remember a patient, a woman, who faced terrible family disputes and most of all, you could sense her personal story was affected by sexuality. She clammed up and told me: 'You do know that in my country we don't talk about those things'. I replied that I did and that it was precisely the reason why she had come to see me. It made her laugh and she started talking. The role of a medical practitioner is also to be able to breach certain rules. Is is also to be able to do what we do not speak. The idea that in a culture you don't talk about particular things doesn't mean you don't think about them. That's all the work I have been trying to do.
K7 : Could go back over the attachment that survivors of the Khmer Rouge regime showed towards their dead and which you observed?
RR : What took me a long time to understand is the fact that there was a presence of the dead which was very overwhelming. Here is a little clinical 'action replay' for you to understand how I became aware of that:
A young Cambodian woman, seen by everyone as gifted, was sent to me by her mother. She had gone through a breakdown before taking her baccalaureate, which she failed, and started suffering from mental anorexia. She was very poorly. Her father was dead. I struggled to get anywhere with that young woman's case so one day, I thought about meeting her with her mother. The mother was desperate because all hope of success had vanished and to her, her daughter would never reach the level she expected – and she had come to France precisely for that purpose. I was slightly intrusive and asked where she was during Pol Pot's regime. The daughter looked at her mother and said: 'Who is Pol Pot?' She had never heard about him! I asked the mother: 'Did you never mention it to her?' 'No, never.' 'Why?' 'Why, because they're all dead!' The daughter then said: 'Oh, I know that, that all my family have died!' I asked her if she had any idea who they were and she said 'no, they're dead!'. It was the first time I heard that: 'they are dead'. The state of being dead – and nothing before that. The mother could not say anything else than 'they are dead'.
This is when I started transforming my job a little. 'But before being dead, what were they?' The mother was taken aback by the question. I continued: 'Because they surely lived, before...!' And I told the daughter: 'The way they died is not your business but before they died is indeed your business. Why don't you question your mother?' Then, all at once, the mother started talking about her father, with whom she had very strong bonds. She explained that he wanted her to go and study, but the plan did not go that far because of the arrival of the Khmer Rouge... It is not the trauma, but what could not be said about another story.
When we honour our dead, we should say we honour our living, who are not any more: we keep a bond there, it is a metaphor. We do not think about them as corpses. I became aware that all my Cambodian patients only talked about one thing, the dead, who are everywhere - which is not the case of the ghosts we encounter in very separate mental worlds, where all sense of reality and real life disappears. […] Then, I went to enquire about the Khmer Rouge propaganda, what they had done... Not about the technical nature of it but about the intention of genocide. Some great texts, like the one written by Primo Levi, recount this attempt of dehumanisation. After that, I read survivors' stories, which had been published, but they were told and addressed in a certain way and you can feel it while reading them. There is almost compassion in the way the narrative is related. I understood that people are always asked to recount stories for the dead. This is why I decided, in the same way that an archaeologist would act, to look for traces of an intention of genocide, from what we see in the consequences this had on psyche, of course, and on society in general. For the dead to be just the dead: this, in my view, is almost the evidence of an intention of genocide. [...] It is impossible to imagine a society without funeral rites, a society which does not honour its dead, and this is what makes us human beings, even in the worst of situations! [...] And the Khmer Rouge tried to destroy that bond between the dead and the living, to annihilate people. The first step of that was to destroy the dead, then kill death, kill the living, and then cut off all social bonds... for beings to find themselves all alone while in the meantime, they keep being told that they must be the element among an unknown multitude, which is not based on networks of solidarity but on the obligation of being multiple...
Finally, the use of death not as a threat. As an anthropologist, I compared this with war crimes. War crimes are synonymous with demonstration. For instance, the mutilation of bodies during the Algerian War. Why? For the person who passes by next can see it! There, in the case of the Khmer Rouge, it's nothing like that! People do not know when executions are going to be carried out, people do not know where the bodies are. Death is not used to terrorise but to be identified with the living. The dead and the living find themselves in the same space. And if Jacques Vergès can say it is the mistake of a small administration and that it is no intention of genocide, he will have to prove why it was done. [...] For every individual, it is not so easy to kill another human being. The Khmer Rouge solved that riddle, you only have to create conditions such that the person you kill is not a human being. And here, you have the framework of the whole genocide. Killing becomes easy, people don't have to be perverts or bastards to do it and they don't even have a guilty conscience afterwards.
K7 : In your job, you do not put much emphasis on trauma...
RR : Yes, for several reasons. I wrote a book with Didier Fassin – The Empire of Trauma: An Enquiry into the Condition of Victimhood [Princeton University Press, due for release in English May 2009], which is not criticism of the trauma, far from it, but a vast deconstruction of the social and contemporary uses of trauma. [...] I reckon that mental health goes far beyond trauma and that focusing on it means taking the risk of sometimes letting many other forms of expression pass us by, whether they be linked or not to that period of suffering.
Trauma is given more importance than necessary, and especially importance of a moral nature. We say: we have to mend these people because they are traumatised. No! We do not mend these people because they are traumatised but because what was done to them is unbearable, unacceptable, intolerable. It is injustice, whether they were traumatised or not. But today, it is one of my greatest fears, we are coming to legitimise a political action in the name of the fact that people suffer psychologically within their soul. But does this mean that if they do not suffer, they can stand and bear everything? Some do not suffer psychologically because of social injustice. But should we just leave them like that? As a psychiatrist, I heal people who suffer, and as a man involved in political action, this categorisation disappears, as far as I am concerned, and I think about the people in need... I am quite hostile to categorisations... [laughs]
The second part of this interview will be published on Monday February 9th.
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