How a Cambodian practitioner helped a community dealing with PTSD : Invisibilia In San Jose, California, a community clinic was stumped as to why their clients were seeing ghosts. This week, a story about grappling with ghosts of our past and one clinic's attempt to heal intergenerational trauma.

Therapy Ghostbusters

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YOWEI SHAW, HOST:

From NPR, this is INVISIBILIA. I'm Yowei Shaw. So when I first heard about today's story, I was like, wow, so many communities are facing this problem. And it's a problem we hear a lot about these days.

(SOUNDBITE OF MONTAGE)

UNIDENTIFIED PERSON #1: Communal trauma, racial, cultural trauma.

UNIDENTIFIED PERSON #2: Generational trauma...

UNIDENTIFIED PEOPLE: Intergenerational trauma.

UNIDENTIFIED PERSON #2: ...Trying to get your head around it.

UNIDENTIFIED PERSON #3: This is not something that a person chooses.

UNIDENTIFIED PERSON #4: I'm in the aftermath...

UNIDENTIFIED PERSON #5: Rejection...

UNIDENTIFIED PERSON #4: ...Of a big catastrophe.

UNIDENTIFIED PERSON #5: ...Abandonment.

UNIDENTIFIED PERSON #4: It's kind of like an invisible elephant in the room.

(SOUNDBITE OF MUSIC)

SHAW: But it's one thing to acknowledge that trauma is real and another to figure out, OK, so what do we do about it? That's something Stephanie Foo has thought a lot about. She's a journalist who wrote a book called "What My Bones Know: A Memoir Of Healing From Complex Trauma." She writes about having complex PTSD, the science behind the diagnosis and the various therapies and treatments used to heal from it. And while researching her book and how to heal herself, she found a story about what it looks like to heal a community. A quick heads up - Stephanie will be talking about genocide, war, domestic violence, suicidal ideation and child abuse. All right. Here's Stephanie.

STEPHANIE FOO: I grew up in a place called the Valley of Heart's Delight, specifically San Jose, Calif. It got that name because it's beautiful - 75 and sunny most of the time, streets lined with cherry and citrus trees, air that smells of eucalyptus - maybe why so many of our parents flocked there. My community was full of immigrants. All of our parents had accents. My high school was majority minority. There was a huge Vietnamese population, lots of Filipino, Mexican, Korean and Chinese kids like me. The local hangout spot was literally called the Great Mall. Though we also played a lot of DDR at Golfland, and every party featured King Eggroll. If you know, you know.

But in this paradise, something darker was happening. You'd catch glimpses of it when report cards came out, when we got caught wearing skimpy dresses at homecoming, when someone's secret boyfriend got found out - because that's when we could expect the abuse at home. Look, it didn't happen to all of us. Lots of us had loving, supportive parents, but it happened to a lot of us, most of my close friends. At home, we were neglected, beaten and yelled at so much that it was normalized in my community. My trauma wasn't just personal. It was shared, with a lot of my friends' traumas, mirroring my own. And we're still affected by it every day.

A lot of things have changed since I was in high school 15 years ago, and I was hopeful that this abuse had lessened in that time. But recently, when I went back to my old high school and I talked to the new counselor there, she said it's still happening, that she has so many students that are being physically abused at home, she can't even count them. When I found this out, I wanted to figure out if there was a way to fix this, to make it stop. For years, I went to therapy, and that helped me. But that was never an option for my parents' generation. I believe that my parents abused me and eventually abandoned me because they were hurting so deeply from their own wounds. And they never sought help for those wounds because they told me that therapy was for crazy people, and they weren't crazy. This stigma prevented most of my friends' parents from getting help, too. So I set out to see if there was a way to heal our parents and in doing so, even heal ourselves.

(SOUNDBITE OF DOOR BEING UNLOCKED)

UNIDENTIFIED PERSON #6: All right. You can set up.

FOO: Oh, great. Thank you. Oh, I love this room.

And that's how I heard about this community clinic in my hometown that was trying to solve the same problem and in the process found themselves in the middle of a ghost story.

(SOUNDBITE OF MUSIC)

DARYN REICHERTER: When something comes at you that you don't know what it is, don't make any assumptions.

FOO: This is Dr. Daryn Reicherter. He's a white dude who kind of looks like Dr. House if Dr. House was really into surfing. And about 20 years ago, Daryn was a young psychiatry resident moonlighting at Gardner Health Services, a community clinic that was providing mental health care to the local Cambodian community. But shortly after starting this job, Daryn noticed something strange.

REICHERTER: At the time, I think we had close to 200 Cambodian patients here. I think we had, like, 180 people. And we kind of got a spreadsheet and realized that almost all of them, maybe 160 of them, were on antipsychotics. I mean, think about that. That's 90%.

FOO: So Daryn immediately thought that cannot be right. Ninety percent of a population cannot be psychotic. That's just not how mental illness works. And if these clients were on the wrong medication, it could have scary consequences.

REICHERTER: Antipsychotic medication is super dangerous. The new generation antipsychotics put people at risk for high blood pressure, obesity, diabetes. What are Cambodian Americans at risk for? - blood pressure, diabetes. And so we're giving them a medicine that puts them even at higher risk for something that's already a terrible risk for them.

FOO: Daryn was stumped, so he asked for help.

BOPHAL PHEN: I got hired not because I has a psychology degree. I got hired because I know Cambodian culture. It's a culture-specific program.

FOO: This is Bophal Phen, a Cambodian therapist who had recently been hired at Gardner. He reminds me of a big, soft teddy bear with '80s-looking wire-rim glasses and a little mustache. He provided case management, counseling and medication support to Cambodian clients. And Daryn thought, in order to get to the bottom of this mystery, he and Bophal needed to reevaluate every single client together. So together, they start with one client. And pretty quickly, she starts telling the two of them about how she sees ghosts at night.

REICHERTER: Luckily, I have Bophal in the room. So I'm able to say, is this symptom, what she's talking about - what the heck, is she psychotic? What's going on? And Bophal said, oh, no, no. This happens all the time. And I was like, are you psychotic? Like, what are you talking about?

PHEN: In our culture, we believe that when you are waking up from sleep, you will see this big, black shadow that sit on you, pinning you down. You cannot wake up. You cannot scream. You cannot move your body. And I think in the Western world, they call that sleep paralysis.

FOO: Sleep paralysis - the feeling you get when you can't move as you're waking up or falling asleep. Daryn and Bophal talked to the clients one by one. Over and over, it was confirmed - all these patients had sleep paralysis. It happens a lot in people who are stressed and not getting enough rest, like these Gardner clients who are often not getting more than two hours of sleep per night. In the end, only about 4 out of the 160 patients were suffering from actual psychosis. So Daryn started weaning the clients off antipsychotics, which, sure, was a relief, but also worrisome that the practitioners had so dangerously misunderstood the ghosts on their clients' chests.

REICHERTER: If I don't take it seriously, you know, I can make a misdiagnosis. But also, I can miss an important part of someone's real, lived experience and just really not be as good of a psychiatrist.

FOO: Daryn said dismissing people's experiences felt condescending, even kind of racist.

REICHERTER: You know, silly little person, there's no spirits. I know better 'cause I'm a scientist - whatever.

FOO: And there was another lingering question - why were so many of the clients suffering from sleep paralysis? If it's caused in part by lack of sleep, then why wasn't anyone sleeping? Daryn had a hunch. As he paged through stacks of hundreds of charts of Cambodian patients, he noticed a red flag. None mentioned the Cambodian genocide.

REICHERTER: Every Cambodian patient I've ever worked with has been affected by Pol Pot. Seeing that the word Pol Pot or the word Khmer Rouge or the word trauma in those charts - right? - you're like, how can you not ask about trauma when you're working with a Cambodian patient?

FOO: No wonder these practitioners had totally misread their clients. They had no idea what their clients had gone through. But Bophal did. And he looked into his own story for clues on how to make the ghosts go away.

PHEN: Frankly, I did not know what kept me going, but I knew that I had to survive. I had to live and not die.

FOO: That's after the break.

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FOO: What was it like for you when you were really young and, you know, you were happier?

PHEN: (Laughter).

FOO: Bophal was born in Cambodia. He lived with his parents and nine siblings. And he said the thing that he remembers about his early childhood was...

PHEN: Back then, I remember that I was able to play. I could make my own kite using old newspaper, catch crickets in a field, finding fish...

FOO: But in 1975, when Bophal was just 10 years old, the Cambodian communist guerillas, also known as the Khmer Rouge, took over the country. Under the dictator Pol Pot, the Khmer Rouge systematically murdered hundreds of thousands of people. They forced most of the surviving population into farm work and manual labor. So at just 10 years old, Bophal was separated from his family and forced to work the fields from dawn to dusk. He only got two small bowls of rice porridge a day, so he was often looking for food.

PHEN: Whether it's wild fruit, rats, frogs or whatever, fish - anything that I could catch, I would eat them.

FOO: Nighttime was hardest for Bophal. He says that some Cambodians believe when you hear the cry of a barn owl, it means that someone has died, and the owl is there to take away their soul. He would hear these owls crying all night in the darkness.

PHEN: Terrifying, every time you hear them cry, for a 10-year-old or 11-year-old, because you know that people are dying. Roughly 2.2 million people, about a quarter of Cambodia's population, died as a result of these policies. In the aftermath, four of Bophal's nine siblings had either gone missing or were dead. After a few years in refugee camps in Thailand and the Philippines, an 18-year-old Bhopal made it to America with his parents and remaining siblings. Things were better, but far from perfect. Bophal's parents turned to him for support - a lot of support. They needed him to fill out forms for social services. They needed him to translate at the hospital because they had a bunch of chronic medical conditions. On top of that, Bophal's parents had mental health issues and struggled with alcohol. Even something like an unlocked door at night could make his parents and siblings panic.

PHEN: They still anxious at nighttime when the - nighttime is the scariest time because it - our body remember that - when darkness set in, the door has to be closed and locked. My mom, my dad, my older siblings, all of them is like, oh, don't leave the door unlocked. Somebody's going to come in and slit your throat.

(SOUNDBITE OF MUSIC)

FOO: Maybe that's why Bophal ended up studying psychology in college.

PHEN: Oh, my God. Started to understand human behavior and what we've gone through.

FOO: And that's how in the early 2000s, after getting the job at Gardner, Bophal found himself trying to figure out not just where the ghosts on his clients' chests had come from, but what to do about them. The ripple effects of the Khmer Rouge were everywhere in this community. Refugees suffered from high rates of anxiety and addiction plus other health problems like heart disease, kidney failure. Gang violence was a big issue, too. Santa Clara County had been trying to support this community with mental health services, but retention rates were miserable, success rates even worse. Psychiatrists even called their patients treatment resistant.

But Santa Clara had just decided to pump a lot more money into a new movement of culturally responsive programming at places like Gardner, which meant hiring a bunch of Cambodian practitioners, like Bophal, and telling them, basically, have at it. Do what you think will help your community heal. Cool. But Bhopal had no idea where to start. So he literally looked back at his psych textbooks from college. And Step 1 was assess the client and find the right diagnosis, which, for these Khmer Rouge survivors, was post-traumatic stress disorder, or PTSD - symptoms like chronic nightmares, trouble sleeping, extreme fear. He expected for this to be a kind of turning point. Like, they'd get their diagnosis and realize, oh, wow, this is serious. I need to get help. But as he saw in his sessions with clients, diagnosing people with PTSD meant nothing to them.

PHEN: Some of them didn't even know what PTSD. But all they know is that you're scared all the time, you're worried all the time.

FOO: And when he tried going home and diagnosing his own parents, it didn't work with them either.

Did you try going up to your mom and saying, mom, I think you have PTSD?

PHEN: Yes. But there's no terminology in most Asian language.

FOO: Yeah.

PHEN: Yeah. There's no term in Cambodian to tell, oh, this is major depression, this is schizophrenia, this is PTSD. But you can say that you're scared all the time because of your trauma from your past. And when there's a loud noise and something happen, you just shake and all of these. And you describe the symptom.

FOO: Yeah. Yeah, yeah. So you explained it to your parents?

PHEN: I did.

FOO: And how did it go over?

PHEN: Well, it's tough because parents, they don't listen to kids.

FOO: Of course.

PHEN: Why would they listen to their son?

FOO: Yeah.

PHEN: My parents did not understand mental health at all. They did not think that they're having mental illness.

FOO: So what could he do next? In school, Bophal had learned to ask new clients open-ended questions like, so what are you in here for? Then, a patient might say, well, I've been feeling really depressed lately and anxious. Or I haven't been able to sleep. But Bhopal's Cambodian clients, they'd say...

PHEN: You're the doctor. You know everything. I don't need to tell you. You should know what I need, right?

FOO: Still, Bhopal tried. Sitting in his office, he used some classic talk therapy techniques like, tell me about your past. Let's process what happened. How is that showing up in your day to day? But his clients were hesitant.

PHEN: For Cambodian, there's a proverb that said, if you have an open sore on your body, why poke it with a stick to cause more bleeding?

FOO: For instance, I talked to a woman I'm calling C. to protect her privacy. She's 60 years old with dyed brown hair and gentle eyes. She told me how her early visits with Bhopal and Daryn - aka Dr. Reicherter - weren't exactly pleasant.

C: (Through interpreter) Me, before, whenever I saw Dr. Reicherter, I was scared of him. Even just seeing him scare me.

FOO: Were you scared of him 'cause he's white?

C: (Through interpreter) No. White people, I'm not scared of them. It was because I saw him typing into his computer as he talked to me. And he would look like the people in the Khmer Rouge tribunal. My mind just go there.

FOO: During the Khmer Rouge, people had been interrogated about their pasts and their education to determine whether they should live or die. So when clients came into Bophal's office and saw his notepad and computer, they didn't see a friendly face or shared experiences. They saw a threat.

PHEN: Clients were, like, throwing up in session, the client was so scared. So they don't want to talk - don't want to be reminded about the killing field, obviously. Why do I do that? When I'm talking about it, it cause more problem, more nightmare, more headache and stuff.

FOO: So to zoom out a bit, lots of trauma treatments focus on exposure therapy. It asks clients to retell or relive their trauma and hopefully get better by becoming desensitized to that trauma. But this treatment can sometimes do more harm than good. People can get triggered and shut down or even drop out of therapy because it's so unpleasant, which is what Bophal was noticing with his clients at Gardner. It felt like everything he knew about therapy just wasn't working. For years, he went to conferences, did a lot of research, tried different modalities. Even his cultural knowledge wasn't really helping.

He didn't know how to heal his friends, his family, let alone his clients. How could he help anyone if they didn't want to talk to him, if the word trauma didn't even mean anything to them? He felt like he was falling short, which isn't surprising, because Bophal and most therapists around him were never taught to treat communities like this. After the break, Bophal leaves the office and tries a different approach.

(SOUNDBITE OF MUSIC)

FOO: For years, Bophal struggled to reach his clients, to help them feel safe enough to open up. But something started to shift in his practice. To understand how, I want to introduce you to S. She's 59, has dark eyes surrounded by tattooed eyeliner, and her whole body starts rocking when she's transported, when she talks about her past.

S: (Through interpreter) Whenever April comes around, my kid know their mom will have heartbreak. They say, oh, heartbreak again.

FOO: Cambodian New Year happens in April, her favorite holiday as a child. But in 1975, just after Cambodian New Year, when S. was 12, Phnom Penh fell to the Khmer Rouge. S. had to watch as the Khmer Rouge murdered 13 people, almost her entire family, right in front of her.

S: (Through interpreter) Of course, that story, there are times when you can put it out of your mind. But how can you forget about it - the blood, the people's throat being cut, my parents throat being slit right in front of my eyes?

FOO: Years later, she came to the United States as a refugee, and she thought she'd be safe. But when she got here, the violence continued. Her husband, also a survivor, became extremely abusive. He threatened her with a gun when she was pregnant, beat her so badly that she's covered in scars. When she tried to take adult education classes, he'd come to her school and scream at her. She endured his abuse for over 20 years.

S: (Through interpreter) I was almost going insane, saying things that were off the mark, sitting somewhere and then just drifting away. I was at zero, not even number one - zero. Absolute zero.

FOO: S decided to divorce her husband, but she didn't have any of the resources to do it - no way to file paperwork, no way to support herself or her kids financially. The Khmer Rouge killed almost the entire educated class of Cambodia, killing teachers, soldiers, doctors, artists and writers. That meant that most refugees couldn't read or write Khmer, making it exceptionally hard for them to learn English. They had trouble navigating the systems around them for support, like school or health care. For S, it was hard to survive, let alone heal, and she was losing hope.

S: (Through interpreter) Like, I was at the end of my life. When you're at the end of your line with no physical strength and no emotional strength, you just want to die.

FOO: And then someone suggested she talk to Bophal at Gardner.

S: (Non-English language spoken).

FOO: S's story - her trauma and her abuse at home - unfortunately, it wasn't uncommon among Bophal's clients. And Bophal was slowly realizing that the reason he'd been hitting a wall was because his clients didn't have the mental space to process the past when so many of them were struggling to meet their basic needs in the present. To feel safe, they had to be safe. And so when Bophal met S. and heard about her abusive husband, he immediately helped her file paperwork for her divorce and found her Section 8 housing and welfare so she could escape her household.

S: (Through interpreter) I didn't know that in this country I have rights. I didn't know. There are people that check in on you.

FOO: Bophal started doing this kind of thing for every client. Remember, Bophal was hired to do counseling and case work for Gardner. So even though he was still struggling as a therapist, he started going way above and beyond as a super involved social worker. He wasn't just booking them health care or welfare appointments. He was also accompanying his clients to every single one.

PHEN: I was driving my clients everywhere. I took them to see every doctor out there, every specialist out there, legal services that they needs, housing, social services, wherever.

FOO: He translated and advocated for his clients at every appointment. He knew how necessary this was because of the years he'd spent doing the same thing for his parents when he was a teenager. And there was an unexpected upside to these drives. He got to spend hours with his clients. There in the car, not in a scary office with the ominous computer, his clients started looking forward to their time with Bophal.

PHEN: So while driving you get a lot more information because it's not like conventional therapy. You're just driving. It's going - how's your life; how's your family? - and all this small, little talk along the way, right? And then you get to a doctor. You fill out a form. You wait to be seen, like, 30 minutes to an hour. You talk more and more. They open up a lot more that way.

FOO: In that car, in those doctor's offices, in their homes where people sat at their kitchen tables, people started to trust him finally. But this was not a quick process.

PHEN: Sometimes it takes a year to a year and a half just to earn their trust.

FOO: To be able to...

PHEN: To tell you the truth, I guarantee you a year to two years.

FOO: For a practitioner to take two years to address trauma, that's pretty unique. But Bophal had to build a remarkably close relationship with his clients before they could even consider being a little bit vulnerable with him. That's what surprised me. Generally, our mental health care system discourages these kinds of super close relationships. There's usually more professional distance. But our system didn't work for both Bophal's clients. Driving around, buying them sandwiches, becoming a part of their lives, that did help.

PHEN: They don't see me as a counselor. They see me as a friend or a brother or father. I don't mind that terminology. If they're feeling comfortable seeing me as a brother, then call me a brother.

FOO: It was then and only then, once they were family, that the real therapy could begin. Clients would open up to him about how they felt, about their anger, their fear. And there was one thing they kept saying, an idea that Bophal worried was keeping them from healing, that they deserved their pain. When a person survives something like this, something truly, unspeakably awful, it's natural to wonder, why did this happen? How could something like this take place? It can't be random. There has to be a reason. And the reason Bophal heard from many of his Buddhist clients was karma.

PHEN: Karma, clients think that you cannot change - unalterable. Meaning whatever that you have, it's there.

FOO: They felt like they had probably done something horrific in their past lives and were being punished in this life. Like, take C. She's the woman with the gentle eyes who was at first scared to open up because the process reminded her of the Khmer Rouge tribunals. When Bhopal met C., she was dealing with trauma from watching many people in her family died during the genocide. And she was also heartbroken. When C. was granted the ability to move to America, she had to leave her husband behind in a refugee camp. Eventually, he got remarried and started a new family, a fact that C. would obsess over for decades.

C: (Through interpreter) The failure of my relationship with my husband, lingering in the form of me constantly thinking about him, missing him, loving him - that was my bad karma.

FOO: Her trauma and her belief that she was doomed made her incredibly anxious. For years, she barely left her house. She'd have panic attacks constantly. Her stress got so bad that she had a stroke. Bophal wasn't religious and at this point didn't know much about Buddhism or karma. But it was coming up all the time with his clients. So he bought books on Buddhist psychology and partnered with a local Cambodian temple where he learned from the monks. And he realized there was another way to understand the concept of karma that could maybe help his clients.

PHEN: Karma is not pain or suffering, karma - just action, thing that you do. It's like the freeway. If you are on that freeway of suffering, you would just go along the freeway. But every freeway has an exit, and that exit require a choice. So same thing with karma. There's always a choice along the way.

FOO: Bophal really wanted to teach his clients that they had agency, that there was hope for change. And so he decided to try mixing Buddhist philosophy with a technique he thought might help, CBT or cognitive behavioral therapy. It centers around identifying negative or unhelpful thoughts and trying to practice better reactions in the future.

PHEN: We don't say, oh, let's do CBT. We would say, OK, like, in Buddhism, you know, how do you commit karma?

FOO: In Buddhist thought, you can commit karma through your words and actions. But you can also commit it through your thoughts by thinking more positively, which Bophal thought was kind of like CBT but more intuitive for his clients like C. She tried Bophal's hybrid of Buddhism and CBT. She liked it, this idea that she was improving her karma all the time just by trying to let go of some of her repetitive thought patterns around her ex-husband.

C: (Through interpreter) Now, not thinking about him, not being reminded about him, not loving him anymore - I think this mean that I don't have that kind of karma anymore. I think that karma can change - change because of our action, the way that we think.

FOO: In moments of crisis, C. would head to Gardner, to the room where they treat Cambodian patients. It has a basket of plastic grapes and rambutans, tea sets, and a small altar with a lot of Buddhas. Then, C. would sit across from the giant wall of windows, bathed in light, and Bophal would breathe with her.

(SOUNDBITE OF MUSIC)

FOO: At first, every time she closed her eyes, she'd see a man coming towards her, grasping for her throat.

C: (Through interpreter) It was difficult inside my body. I was unable to breathe.

FOO: But every time they'd breathe together, she could keep the man away for a little longer. Eventually, with the help of medicine and meditation, she started leaving her house, volunteering at the temple, and learning to make new friends. Plus, she went from sleeping two hours a night to 11 or 12.

C: Feel fresh, you know?

FOO: Feel good in the morning.

C: Yeah. Feel good in the morning. Like, (vocalizing) I'm alive. I'm alive, you know?

FOO: (Laughter) Yeah.

Bophal was figuring out what culturally responsive care actually looked like for his clients. But what about the people around them - their kids, their grandkids? After the break, Bhopal takes on intergenerational healing.

(SOUNDBITE OF MUSIC)

FOO: Where I grew up in San Jose, so many of our parents had fled conflict and poverty just like Bophal's clients. They were refugees and sometimes veterans of the Vietnam and Korean Wars, Chinese parents that had escaped the Cultural Revolution where some had been in labor camps. My own parents were born during the Malayan emergency, a brutal war that targeted ethnic Chinese and caused my grandfather to be imprisoned for five years. And maybe that pain was trickling down to the kids. Like, in my case, I endured really extreme abuse growing up.

(SOUNDBITE OF MUSIC)

FOO: My parents held knives to my throat for talking back. I was beaten so severely that I thought I might die. Both of my parents abandoned me for other families by the time I was a teenager. So even though Bhopal was finally helping survivors cope better with their trauma, there was still one critical problem that I was most curious about, the question that could have helped me. How could he help his clients stop passing their trauma down to their kids? C, for instance, the woman with the gentle eyes who missed her husband - for a long time before meditation, therapy and medication, she struggled with her children.

C: (Through interpreter) In Cambodia, when children don't listen, we can hit, discipline them. But here we cannot. If we hit them or something like that, there will be problems legally. It is difficult to raise them.

FOO: At one point, she was estranged from all five of her grown children. Bophal would hear about what happened in other homes, too - corporal punishment, emotional abuse.

PHEN: You know, mom and dad screaming, yelling all day, all night long, a lot of stress. And, you know, that's not a good feeling.

FOO: This is T. His parents were Cambodian genocide refugees in San Jose. And to cope with the chaos at home when he was growing up, T. turned to a different community.

T: So instead of coming home, you'd stay after school. And you're out in the streets pretty much. I pretty much got involved with gangs. You know, I had a lot of friends that end up going to jail, doing life in prison. Some of my friends died.

FOO: When parents would hear about their kids joining gangs, they couldn't understand how this had happened. Wait, they thought. We escaped a war zone just so you could replicate one here? But that's what happens when trauma goes untreated. It can ripple out and harm others.

(SOUNDBITE OF MUSIC)

FOO: I have met so many Asian parents who have fled conflict and who don't like to talk about their pasts, the whole not-poking-the-wound thing. But also, they believe they can protect us from that trauma by not sharing it. I had never even heard about what my grandparents had gone through IN the Malayan Emergency until I started researching it for my book when I was 31 years old. Most of my friends didn't know the details of the Vietnam or Korean wars either, and we definitely didn't learn about the Khmer Rouge in my school in San Jose. Our parents were failing us. But what was missing was why. We had no context. And neither did a lot of Bophal's clients. So one day when a young woman complained to Bophal, my mom is nagging again. She's so crazy.

PHEN: It was like, you know what? Just for your information, your mom is not crazy. It was, like, eye-popping for this young lady. It's like, what are you talking about? In a way, I was like, you know, what your mom's been through is killing field of war and stuff. I started to talk about Cambodian history, open up her mind a little bit.

FOO: The woman was shocked, and Bophal realized these kids had to know what their parents survived. So for 10 years, Bophal volunteered at a Saturday school for Cambodian children to teach them to read and speak Khmer and to learn about their culture, including lessons on the Khmer Rouge. In T.'s case, when he learned his parents' story, it changed the way he saw them.

T: Once I was able to hear what my family went through, and then I kind of, like, understood, like, you know, it's not really their fault, you know? And so it gave me a sense of healing. You know what? Hey, my parents aren't bad. My parents had problems, and they didn't know how to cope with it. You know, they tried their best.

FOO: Eventually, T. left the gang and turned his life around. He got his degree and joined Gardner, where he worked for years as a counselor to youth in gangs. And when he'd tell them about their parents' history...

T: They see more empathy, you know, for the parents. And then they started to maybe say, you know what? I'm just putting more hurt on my parents when they've been through a lot already. And here I am messing it up for them.

FOO: Of course, just having that context is not necessarily enough. When I learned about the Malayan Emergency, I had more empathy for my parents. But one-sided empathy can't heal a relationship. Obviously, the most important change that needed to happen was for parents to parent better. So in order to truly repair these relationships, Bophal helps survivors learn to parent in a healthier way. Like, he told many parents, hey, instead of hitting your kids, maybe try taking away privileges. And he tried helping people like C. better communicate with their kids.

C: (Through interpreter) One story - a daughter that lives far, I miss her. And I want her to visit me because she said that she's working and doing more school. So then I asked her once, twice, but she still didn't have time. So I wanted to scream, oh, God, just visiting your mother is impossible? But after learning from Bophal, I didn't scream. I instead compromised with her and said, when are you free to come visit me? Do you know that I miss you? And saying kind words, like asking nicely and not aggressively demanding what I want. Then suddenly, she was still and didn't say anything. And then two days later, she visited me as a surprise. Because I talked, asked in the new way, she came to see me.

FOO: Her relationships with most of her children have been improving steadily ever since. Bophal and his team have now been practicing these techniques at Gardner for about 20 years. And Daryn, who now specializes in creating culturally responsive treatment programs for refugees, he says he still hasn't seen this level of success in any of his other programs anywhere. Lots of other programs implement things like prioritizing social work, relationship and community building, being respectful of cultures and religions. But Gardner still stands out. Clients stick around for decades. Many find community at temple. Some have fewer nightmares. Others graduate from the program altogether.

It's a hard job, though.

PHEN: But I feel that my skill - I could relate with them. I could help them. Therefore, this is the place for me. This is the place where I kept coming year after year. I did not move up. I did not move on. I'm just staying where I am.

FOO: Both C. and S. recommend Bophal to anyone who will listen and have convinced some of their friends to come to Gardner. I mean, to any Asian kids of immigrants, seriously, two 60-year-old immigrant women insisting to all their friends that they need therapy.

C: (Through interpreter) My friends, when they looked at me before, they could see that I was sick every day. But now, these past two years, how could I become cheerful and agreeable and not be sick? I would tell them that this place is not the place for crazy people. This is a place for healing.

S: (Through interpreter) The warmth and comfort from them constantly checking in on me, it protected me. This place is a safe space. Even if you want to die, they won't let you die. They wouldn't let me hurt myself. This is where people live. It helped me survive. It gave me hope.

FOO: Honestly, I got emotional listening to these testimonies and conveyed this to C., the woman who was able to convince her daughter to visit her in healthier ways.

And me personally, I really wish that my parents had gotten help so I could have a better relationship with them. I think it's, like, a beautiful act of love for your kids that you are taking care of yourself.

PHEN: (Non-English language spoken).

C: (Through interpreter) Oh, your parent have family issue, too?

FOO: I haven't talked to my mom since I was 13.

PHEN: (Non-English language spoken).

C: (Through interpreter) Because of conflicts? Is she still around? Maybe she need treatment, counseling.

FOO: (Laughter) Yeah, she doesn't want to go. But I'm so proud of you for going.

In interviewing C. and S., I thought often about what would have happened to me and my classmates if our families had participated in a program like Bophal's. What if my parents had gotten those parenting lessons? What if they'd learned how to better manage their own pain? Maybe they could have fought less with each other. Maybe I wouldn't be estranged from both of them now. Maybe we could have all felt a little bit safer. Maybe I would have been loved like I deserved. What a dream, right? But for any of that to have happened, my parents would have needed to be OK with getting help. They would have needed to understand that going to therapy didn't mean that they were crazy, which makes me wonder - if I dared to keep dreaming - what if going to therapy wasn't walking into someone else's office? What if it was about opening a door for someone to walk into your life to help you learn how to love and be loved in ways that made sense to your culture and your community? What if your trauma wasn't yours alone to carry? I think that world, it just might have a lot more joy in it.

(SOUNDBITE OF MUSIC)

FOO: At one point in my conversation with C., she got tired of talking about her trauma and just wanted to show me and Bophal cute pictures of her grandkids.

C: And I just want you to see my daughter.

FOO: You're going to show me more pictures?

C: Yeah. Picture, picture.

FOO: Very cute.

C: I know, Cambodian.

FOO: (Laughter).

Remember how hard the Cambodian New Year could be because it marked the week the Khmer Rouge came to power? But C. brought up colorful pictures of this year's celebration.

C: I want to show you the New Year, New Year.

FOO: Oh.

C: Look at the temple. Yeah.

FOO: New Year can be happy again.

C: Oh, my God, it's so happy.

FOO: Bophal sits and watches, smiling.

PHEN: And that's the moment you go like, yeah, I feel good (laughter).

(SOUNDBITE OF MUSIC)

SHAW: That's Stephanie Foo. You can check out Stephanie's book about her own mental health journey. It's called "What My Bones Know: A Memoir Of Healing From Complex Trauma." And one thing we want to note, Stephanie told us that Bophal's success with his clients would not have been possible if Santa Clara County didn't invest in culturally responsive practitioners 20 years ago. The kind of labor-intensive care that Bophal has provided - treating people over many years, treating entire families, spending time in the car with them - that all costs lots of money. But in recent years, even Gardner has faced budget cuts. And Bophal and his team have been forced to significantly reduce the number of clients they're able to serve. It's something they're hoping will change in years to come.

(SOUNDBITE OF MUSIC)

SHAW: This episode was produced by Lee Hale, Ariana Gharib Lee, Phoebe Wang, Nic M. Neves and me, Yowei Shaw. This season of INVISIBILIA was also produced by Kia Miakka Natisse and Abby Wendle, with more production support from Clare Marie Schneider and Andrew Mambo. Our intern was Sara Long. Our supervising producer is Liana Simstrom. And our supervising editor is Neena Pathak. Fact-checking by Jane Drinkard. Translation and interpretation by Ryan Boun. Voiceovers by Sania Khalil and Tevi Woehl. Additional research help from David Gutherz and Lauren Beard. Mastering by Josh Newell. And legal and standard support from Micah Ratner and Tony Cavin. Special thanks to the many survivors at Gardner who were so generous with their time. Additional thanks to Sophia Rath, Susan Simonds, Carmel Wroth, Rhitu Chatterjee, Sivind Tep, Mo Yeav, Asian Americans for Community Involvement, Melanie Young, Venerable Abbott Rathana, the San Jose Cambodian Buddhist Society, Jennifer Schmidt, Luis Trelles, Adelina Lancianese, Gregory Warner and Catherine St. Louis of Neon Hum Media. Our technical director is Andie Huether. Our deputy managing editor is Shirley Henry. And our senior vice president of programming is Anya Grundmann. Theme music by Infinity Knives, and additional music in this episode provided by Ramtin Arablouei, Connor Lafitte, Infinity Knives, Magnus Moone, courtesy of Tribe of Noise. And special thanks to Peals, courtesy of Thrill Jockey and by arrangement with Bank Robber Music. OK. We will see you next week.

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