Cambodian soldiers took away Bun Hap Prak's brothers forever one steamy night in 1976. For many nights after that, Prak stayed awake _ waiting for a knock on the door, for the soldiers to return. This time, they would come for him.
The once-outspoken university student was wracked with anxiety. He grew increasingly withdrawn, hoping to avoid the eyes of the Khmer Rouge soldiers who took over the country.
When Prak finally arrived in the United States six years later, his problems followed.
"I was very quiet," he said. "I didn't say anything. When I went to college, my professors wondered, "Why are these Asian people so quiet?' My counselor told me, "You here, speak up.' The only way to escape the trauma, the tragedy, is to close their minds."
Today, Prak and other Southeast Asian refugees are trying to reopen their minds.
When they began settling in the United States more than a decade ago, the refugees struggled to find homes and jobs.
Now that many of their material needs have been met, those refugees are trying to come to terms with their history. Many are starting to confront sometimes serious mental disorders that have roots in their native countries, their perilous journeys and their new lives in a new home.
They are starting to openly discuss their anguish. As Tampa Bay's Indochinese population grows _ the area has the largest such concentrations in Florida, with 2,400 in Pinellas County and nearly 1,100 in Hillsborough _ those wounds are becoming increasingly evident and the focus of attention from experts.
In an attempt to encourage the healing, leaders of the Cambodian and Laotian communities in St. Petersburg organized a conference in April featuring experts from around the county. Among the guests were the Cambodian refugee whose story was told in the movie, The Killing Fields, and the actor who played him.
Two weeks later, the 12th annual national conference on Indochinese Education and Social Services featured experts who talked about the problems refugees face, including depression.
Experts agree that social agencies and psychologists often are ill-equipped to deal with the mental problems refugees face. Counselors are confronted with extreme cultural and language barriers and the reluctance of refugees to seek help.
Memories of death
For refugees, the pain can come from memories of torture and death. In Cambodia, for example, the Khmer Rouge are blamed for killing at least 1-million people during its four-year reign beginning in 1975. Virtually anyone who might have posed a threat to the government was killed.
Haing S. Ngor, the doctor who starred in The Killing Fields, was tortured a number of times. Once, soldiers tied him to a tree, allowing red ants to cover his body with their painful bites. Other times, he was beaten. And he had a finger chopped off as a warning that his head would be next.
"Too many have been tortured and mutilated," he said. "I have seen my family killed. Unfortunately, I was not unique in my suffering."
Statistics document that suffering. Compared to the average American, Cambodian and Laotian refugees are six to seven times more likely to exhibit severe mental health problems, one federally funded study in California shows. They are two-and-a-half to three times more likely to show a "moderate need" for mental health care.
The same study showed that the Vietnamese refugees have about twice the severe and moderate needs for therapy. Post Traumatic Stress Disorder, with symptoms including flashbacks, hallucinations and extreme anxiety, also was prevalent.
Sixteen percent of the Cambodians in the study suffered from it; 12 percent of the Laotians and 5 percent of the Vietnamese also did. The study surveyed a random sampling of 2,773 Southeast Asian refugees in California.
"It's not that the refugees per se have a high number of mental health problems, it's the refugee experience," said Richard Cravens, director of the Office of Refugee Health of the U.S. Department of Health and Human Services. "These people fear persecution or have been persecuted. The anxiety, the anguish starts at the time they are aware of the persecution and decide to leave the country. It's this experience."
The mental disorders range drastically in severity. Refugees who have witnessed or experienced extraordinary violence sometimes suffer from Post Traumatic Stress Syndrome. Others suffer from depression and anxiety.
"When I first came here, I was thinking about going back to Cambodia," said Bun Hap, 36, who lives in St. Petersburg. "It seemed like you hit your head against the wall. You feel like nobody is listening. Where can I get help?"
He said he has taken at least six people to mental health clinics for treatment. Their symptoms were serious _ hallucinations, flashbacks and depression.
Bun Hap, a leader in the Cambodian community, still suffers from flashbacks. Sometimes they last only seconds. Other times, minutes.
A field, a farm scene or discussing the past can trigger those feelings. It has taken Bun Hap 10 years to talk about his past.
"They don't understand'
Other refugees face mental health symptoms that surface months or years after their contact with refugee organizations ends and they are on their own.
"When they get to the United States they have a honeymoon," Cravens said. "In about two or three years, there's some shattering of this illusion. What we found in the refugees is depression, major depression."
Anthony Traynor, a family therapist in St. Petersburg who is active in the Southeast Asian community, said Cambodians and Laotians face unemployment, school-related problems, spouse abuse and even alcoholism. Often they are under pressure because poverty forces the families to live together.
"The professionals, they don't understand this," Traynor said. "They think it's just a community that needs to pull itself together like every other immigrant community. What they don't understand is that these are refugees, they are not immigrants. The difference is that the refugees are forced to come here. They don't choose to come here."
"The ones that we have in this area are socially and economically disadvantaged, even by Southeast Asian standards. . . . Whole families are wiped out in Cambodia. What the hell are they supposed to pull together?"
As the years go by, tensions can develop between the elders in the Asian community and their children. Although the adults may maintain their traditional values, their children often become quickly Americanized. They play baseball, date, go out dancing and drink beer.
Thomas Phetsadasack, 25, also of St. Petersburg, arrived in the United States with his mother and brother and sisters in 1979. His father, a full colonel with the army in Laos before the Communists took over, had been forced into a re-education camp where he remained until a few years ago.
Like many Laotian youths, Phetsadasack was raised by his mother. She was terrified of Americans and sometimes refused to leave the house. She was incapable of understanding the changes she witnessed in her son, Phetsadasack said.
His mother worried about him failing in school, even though his grades were adequate. Phetsadasack said she feared he would get involved with an American girl _ a dramatic split from a society where marriages are arranged. She also worried that he was losing his respect for family and the traditions of their native land. Sometimes when Phetsadasack didn't come home until late, she locked him outside.
He grew increasingly rebellious.
"I would talk back to her," he said. "She got real mad because it's not proper to talk back to your parents. . . . I want to do things my way. I want to do it by myself. Isn't that pretty much American? The Eastern way is more family oriented, where everybody kind of supports each other."
It wasn't until Phetsadasackstarted talking to a high school counselor that his rebellion lessened. The counselor, Don Pemberton, helped Phetsadasack raise his self-esteem and discover himself. Pemberton also got him a scholarship to a small college in North Carolina.
Today, Phetsadasack is working on a master's degree in counseling at the University of South Florida. Pemberton said someone just had to "light that spark."
Nowhere to turn
Not everyone adjusts or learns how to deal with the past.
Many refugees are reluctant to get help. Many are skeptical of psychologists.
"In Cambodia, psychology or mental health is very far behind," Prak said. "So the psychological or mental problem, we don't see as a problem."
Like others, Prak has tried to deal with his problems alone. He thought that if he could survive genocide, he could survive anything. Talking with other refugees helps him, he said.
But Traynor said few refugees have Prak's coping skills.
"He's a leader," Traynor said. "He was a leader there. He's a leader here. . . . He's educated. He speaks good English."
Sharon Cilles, a therapist at the Suncoast Center for Community Mental Health in St. Petersburg, said refugees avoid counseling unless they are seriously ill. Therapists at the center are treating four Vietnamese refugees with problems ranging from schizophrenia to depression.
Language can be a barrier. If the interpreter is a family member, clients may be reluctant to talk openly. And the interpreter may not be objective.
"It's always from the interpreter's frame of reference," Cilles said. "Especially, if it's a family member. They hear one thing. They may only give their side of it."
Traynor said he knows of no therapists in the area who speak the native languages of the refugees or are acquainted with their history. Until this happens, refugees will remain reluctant to seek help, he said.
Prak remembers getting a call about a woman who started crying while she was looking out the window. The windy, cloudy day had brought back memories of Cambodia and her dead relatives.
Prak said he rushed the woman to a local mental health clinic, serving as an interpreter. His efforts didn't pay off. The woman left with a prescription but no solution.
On certain days, when the sky is gray, Prak said, tears still come to the woman's eyes.