Culture, Trauma, and Confinement: The Making of Psychiatric Knowledge in Refugee Camps

This paper will examine the history of psychiatry through the lens of the refugee camp, which, I argue, has served as an instrument of accumulation and extraction of knowledge about refugees and their mental (ill)health. Though the voices of refugees are often absent from the psychiatric knowledge created about them, they have nonetheless contributed to and shaped subfields of psychiatric knowledge and practice, such as trauma psychiatry and transcultural psychiatry. Two very different mental health programs delivered by medical humanitarian organizations to Cambodian refugees encamped on the Thai-Cambodian border will be examined, from both the earlier and later years of a humanitarian border crisis that lasted from 1979-1993. Different psychiatric methodologies were introduced, applied, and refined in Cambodian refugee camps, contributing to the genesis of ‘new’ fields of ‘refugee mental health’ and ‘refugee trauma’. The first of these programs involved the appropriation of indigenous knowledge by the International Committee of the Red Cross (ICRC), which eschewed Western psychiatric concepts completely in favour of Khmer traditional medicine. ICRC set up and administered Traditional Medicine Centres that were staffed by krou khmer, Cambodian Buddhist monks, who practiced their indigenous healing traditions within the framework and limitations set by ICRC. The second involved a landmark study by the Harvard Program in Refugee Trauma, which introduced and applied new Western psychiatric tools, such as the DSM-III, and diagnoses, like PTSD, in Site 2, the largest camp on the border.