title: Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead.
abstract: This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and post-traumatic stress disorder (PTSD) interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about "bad death" and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76 % of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in "category truncation," i.e., a lack of content validity, a form of category fallacy.
authors.affiliation: Arbour Counseling Services, Lowell, MA, USA. devon_hinton@hms.harvard.edu
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.forename: Sonith
authors.initials: S
authors.lastname: Peou
authors.forename: Siddharth
authors.initials: S
authors.lastname: Joshi
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Simon
mesh_terms: D044466:Asian People / Q000208:ethnology; D001601:Bereavement; D002160:Cambodia / Q000208:ethnology; D003469:Culture; D003643:Death; D004325:Dreams / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D063365:Genocide / Q000523:psychology*; D006117:Grief; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000208:ethnology; D008875:Middle Aged; D012036:Refugees / Q000523:psychology*; D012720:Severity of Illness Index; D029181:Spirituality; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology*