The prickle of emotion catches the young psychiatrist unawares. Kim Sieng unexpectedly moves him. She sits 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 he feels an 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.
They sound as stilted as each other, so he gestures towards her weak arm, and she allows him to flex the joints. The arm is completely limp, and the image of Kim Sieng as a broken doll
flashes through the young psychiatrist’s mind. There is something amiss. If she were suffering the after-effects of a stroke, as her GP had at first suspected, her arm would have gradually stiffened—moving it should have felt more like opening the blade of a penknife. Kim Sieng’s right leg was also partially paralysed, though she could still walk with a debilitating limp. Nothing had been found to explain the paralysis.
The translator arrives, full of apologies. A student doing translation jobs to help pay his way, he explains that this is mostly written work: it is rare 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 isn’t Chinese—as does her name. He asks the translator to apologise for his mistake, though Kim Sieng has taken no offence. The translator explains that she 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. Kim Sieng responds with simple answers. She 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 therefore 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 had been taken away and she had never seen them again.
At this point, Kim Sieng speaks to the translator of her own accord. Tilted sideways, she says she is very ill, and could the doctor please give her some medicine.
The young psychiatrist asks the translator to explain 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 fortunate; they had found each other again, and near the end of the “Pol Pot time,�? got across the border into Vietnam and, with the help of cousins, to Europe. “Do you miss your husband?�? the young psychiatrist asks. Kim Sieng is not affronted by the banality of the question. “Yes,�? the translator explains. “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 had suffered a stroke, leaving him with a weak arm and leg. Scans had shown a tumour eating into the vessels supplying his motor cortex—a clear, visual image of the neurological links to his paralysis. Kim Sieng had 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, some sceptics will 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 psycho-somatic reaction, its symbolism is the most tragically symmetrical that the young psychiatrist has come across. Kim Sieng not only manifests 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.
A Cambodian monk once told Kim Sieng that people’s pain is caused by crimes they committed in previous lifetimes, that there is no cure for suffering. The only solution was acceptance, to move on.
The young psychiatrist, however, does try to do something. Kim Sieng resists all suggestions of physio-therapy, Chinese massage, or acupuncture. So he prescribes Citalopram, a modern anti-depressant. She takes them gratefully. Over the following weeks, she says the pills help. But she still limps, and holds her useless arm. One day, curiosity overcomes the young psychiatrist, and he follows her out of the hospital and down the street, to see how she behaves on her own. She still limps, and holds her arm. The young psychiatrist again feels a stab of pity, perhaps precisely because she 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.
