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Abstract
This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1–44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.
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1 Center for Anxiety and Traumatic Stress Disorders, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
2 Leiden University Medical Center, Leiden, The Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; School of Child and Adolescent Health, The Children’s Institute, University of Cape Town, Cape Town, South Africa
3 Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands