Some kinds of historical experience leave a mark that cannot easily be erased. One legacy of recent times in Cambodia is an extraordinarily high level of mental illness seen in victims of trauma -- a level so high that individual treatment is not possible. PNS associate editor Andrew Lam traveled to Cambodia on the eve of the 25th anniversary of the Khmer Rouge takeover of Phnom Penh on April 7, 1975. (Second of two parts)

PHNOM PENH -- The old woman wrapped in a faded sarong is screaming at a flame tree on Sihanouk Boulevard this morning. Passers-by eye her warily. A young teenager in blue pants and white shirt school uniform pauses, taps on his own temple, then giggles. "Chkuot (crazy)," he says.

The old woman, alas, is not alone. The world's attention has moved on but Cambodia, after three decades of warfare, remains a country plagued with problems, chief among them mental stress and illnesses. Approximately one out of three people suffers from Post Traumatic Stress Disorder, according to a recent survey found based on 700 in-depth interviews conducted by TPO (The Transcultural Psycho-Social Organization). In all, up to 40 percent of Cambodians have trauma-related mental illnesses and 15 percent are virtually incapacitated.

It's a country full of disturbing flashbacks and nightmares and murderous impulses. "It's alarming," says one foreign health worker. "If you count up all kinds of mental related symptoms, it's probably two out of three people."

But Kall Kann, director of the Dutch-supported TPO program, warns "people should take the survey with a grain of salt....There are not enough statistics to make accurate measurement of the problems here." Kall, 30, lost four members of his own family during the Khmer Rouge reign when more than 1.5 million Cambodians perished. Essentially everyone old enough to remember the war is related to, or knows, someone who was killed.

Kall says he is strong and busy, and optimistic. Above all, "I focus on one thing and I can forget about the rest. This is my survival skill." Yet Kall also warns of "a culture of mistrust and violence here that affects everyone. There is peace now but the problems and violence continues."

Kathleen Hayes, managing director of the small but influential Phnom Penh Post, says, "Cambodia is a country where most people have been personally traumatized and the rest are nurtured from those traumatized people." There are very few positive models, she adds. "The police brutality is legendary here."

Sophal Ear, a World Bank executive and Cambodian American who comes here frequently, observes, "The threshold for violence seems really low in Cambodia. I think it has something to do with the value of life in Cambodia....beating someone to death isn't going to land you in jail. You can't count on the courts, so you get retribution immediately."

Violence, in fact, becomes part of the communication process, says Doctor Mustafa Elmasir, a consulting psychologist from Palestine. "Cambodians are not known to talk about their problems. They simply hold it in and then express it through violent acts."

Thus treatment is a Herculean task. How can an individual be treated for a disease that has, in effect, infected the whole society? Worse, in a country where surviving is the order of the day, where violence continues, where land mines have created more amputees per capita than anywhere else in the world, and where the poor/rich gap is so vast now that the poorest feel dehumanized, psychological treatment is the lowest priority.

Traditionally, people with mental problems have been chained to their beds or simply left to die by relatives in the forest. Some seek solace in Buddhism but Kall is skeptical. "Buddhism is interpreted as acceptance of karma here. People are told to accept their fate so they don't deal with their problems adequately."

Ultimately, individual treatment is not as effective as group treatment, Dr. Mustafa says. "Counseling in Cambodia has to be done within the context of family and village."

Kall cites the case of a woman whose father and husband were killed during the Khmer Rouge time but remade her life and the life of her children. Then her two sons stepped on landmines -- one was killed, the other injured, and she went into withdrawal.

TPO's health workers approached her repeatedly until she finally told her story. "She cried for three hours and then she kept telling her stories until she got better," Kall recalls. But TPO went further -- they asked neighbors to help the woman, and with their help she opened a baked goods shop. She is now a volunteer with the TPO group for workshops to help others like herself.

She is an exception. Cambodians seem caught in a curious dilemma: the past holds such a grip on the present, but it is a past that has very little way of expressing itself, except through flashbacks and nightmares and through violence.

The government, pressured by the various NGO, now requires medical students to take course in mental health. "Cambodia needs a lot of help," says Kall," unfortunately much funding is drying up as the outside world perceives needs elsewhere."

Without proper treatment, Kall says, the country will be in limbo a long time. "If people are sick and can't work, the economy is never going to grow."

Sophal Ear says he is optimistic when he goes to Cambodia, depressed when he leaves.: "Still these days, I tell you, if there's a will, there's a way for Cambodians. After the Killing Fields, I think we, as a people, decided that survival was up to each and every one of us. We've been to the bottom, and there's nowhere else to go now but up."