Out of mind

A Cambodian woman is paralysed just like her husband, but she has not had a stroke. She is in a grey region of "conversion disorders"
May 19, 2006

Kim Sieng sits in the consulting room with her right arm cradled in her left hand and her body tilted to one side, as if she were holding herself in a permanent state of falling. She is small and frail, and the young psychiatrist feels an odd impulse to reach out and catch her. Instead, since the translator is late, he tries some pidgin Chinese. "Ni hao," he says. "Ni hao," replies the elderly lady.

He gestures towards her weak arm, and she allows him to flex the joints. The arm is completely limp. Something is amiss—if she were suffering the after-effects of a stroke, as her GP had at first suspected, her arm would have gradually stiffened. Extending it should have felt more like opening the blade of a penknife. Kim Sieng's right leg is also partially paralysed, though she can still walk with a debilitating limp. Nothing has been found to explain the paralysis.

The translator arrives, full of apologies. He mumbles that he normally does written work: it's unusual to come across other Cambodians in Britain. Now the young psychiatrist feels foolish for his "Ni hao" to Kim Sieng. The referral letter makes it clear that she is not Chinese—as does her name. He asks the translator to apologise for his mistake. The translator explains that Kim Sieng is Chinese-Khmer, a large Cambodian minority. After 20 years spent living within a Chinese community in this country, she does speak a few words herself, though not very well. Her husband used to do all the talking.



Kim Sieng and her husband had been married for 42 years and now that he is dead, she is alone in the world. The young psychiatrist asks her to explain what had happened to her in Cambodia. She responds with simple answers. Kim Sieng and her husband had once run a small business in Phnom Penh, before joining the Khmer Rouge. "Just middle-ranking officers," the translator quickly explains, as if diffusing the possible implications of this. In 1975—"year zero"—when the Cambodian capital was evacuated by Pol Pot's forces, Kim Sieng and her husband had been sent out to the countryside to organise work in the fields. But soon afterwards, they were exposed as former business people, and thus enemies of the revolution. They were purged from the party, split up and sent to work in the fields themselves. "Not the worst places," Kim Sieng adds. But her two children were taken away and she never saw them again.

At this point, Kim Sieng speaks to the translator of her own accord. She says that she is very ill, and could the doctor please give her some medicine.

The young psychiatrist explains that he is not a normal doctor; that she is here because the other doctors don't know what is wrong with her. It may be that some of the things that happened in her life have made her ill. Kim Sieng replies that she and her husband were more fortunate than other people; they found each other again, and near the end of the "Pol Pot time," got across the border into Vietnam and then to Europe. "Do you miss your husband?" the young psychiatrist asks.

"Yes," the translator responds. "They used to do tai chi together."

"And can she do tai chi now?"

"No, her arm makes this impossible."

Six months ago, Kim Sieng's husband suffered a stroke, leaving him with a weak arm and leg. Scans showed a tumour eating into the vessels supplying his motor cortex—a clear, visual image of the neurological links to his paralysis. Kim Sieng cared for him, encouraged him to do tai chi, helped him wash. But then, three months ago, he suffered another stroke, this time a massive one, which killed him. When Kim Sieng began showing similar signs of paralysis, however, nothing showed up on the scan, and the neurologists were left flummoxed by her symptoms. So the young psychiatrist now finds himself groping into the grey area of "hysterical paralysis" or "conversion disorder"—part Charcot's 19th-century notion of a dynamic neural lesion, part Freud's idea of psychic conflict manifested as a physical symptom. Despite current attempts to provide cognitive models of willed action in disorder, sceptics still describe hysteria as fakery.

The young psychiatrist asks if Kim Sieng feels depressed. She says she doesn't. He asks if she wants to talk more about her husband. Again, she doesn't. Suddenly, he is conscious of a poignancy that Kim Sieng does not herself express. He can't resist the impression that she has somehow embodied her grief, telling him about it with her body. Somatisation is known to be particularly common among Asian women, but if this is indeed a psychosomatic reaction its symbolism is the most tragically symmetrical that he has come across. Kim Sieng not only displays symptoms that are sympathetic with her husband's first stroke, she has lost the use of half her body—just as she has lost her other half.

Kim Sieng resists all offers of physio-therapy, Chinese massage or acupuncture. The young psychiatrist prescribes Citalopram, an anti-depressant. Over the following weeks, she says the pills help. But she still limps and clutches her useless arm. One day, curiosity overcomes him, and he follows her out of the hospital and down the street, to see how she behaves on her own. He feels a stab of pity—perhaps because Kim Sieng now walks a bit straighter, and when she gets to the bus stop, she reaches awkwardly into her bag for her pass. With her right hand.