It was 35 years ago that Vietnamese tanks rolled into Cambodia's capital and put an end to the four-year reign of genocidal terror that wiped out a quarter of the population through starvation, torture and execution. A tidal wave of desperate refugees rolled across the border to encampments in Thailand; eventually, thousands joined a thriving community of Cambodians who had settled in Long Beach, California.
There, in the 1980s, doctors began noticing an unusual phenomenon -- some of the resettled Cambodians, mostly older women, were having problems with their vision that could not be linked to any physical cause. "Unknown etiology" would be the formal way to describe it.
But medicine abhors a mystery, and speculation as to the cause soon arose -- these survivors of war and terror could not see because they would not see, doctors concluded. They were so traumatized by what they had witnessed and suffered that their vision was impaired. They were experiencing hysterical blindness.
"Blinding Horrors : Cambodian Women's Vision Loss Linked to Sights of Slaughter," was the LA Times headline in 1989.
"Eang Long cried for many days after the Khmer Rouge soldier beat her brother and his three children to death," the story begins. "'My eyesight started to get terrible after I saw the tragedy'," Long said. "Because I was crying so hard and long, my eyes were red and started to swell up. Then I started to have problems with my eyesight."
In the face of such horror, any human reaction seems possible. Researchers identified 30 Cambodian refugee women 40 to 69 years old with a similar pattern and gave them a battery of tests, including brain waves. (Some men were also affected, but focusing on women makes "hysteria" a simpler argument.)
"In each case, the test revealed normal visual acuity, often at the 20/20 or 20/40 level. These same women, however, when looking at an eye chart could barely see the top line of 20/200--the point of legal blindness. Other women had no light perception and could not detect light or dark shadows. ...
"Most of the women's functional blindness surfaced during the Pol Pot years. Personal interviews brought out repeated stories of forced labor, the murder of family and friends--often in their presence--beating and torture, starvation, a treacherous escape to Thailand and separation from family.... The findings indicated that the longer a woman was bound to Khmer Rouge servitude or life in a refugee camp, the more her vision was impaired."
In other words, the longer the time in which a woman spent in such conditions -- and some were in the Thai refugee camps for up to six years after four years of the Khmer Rouge horror -- the worse and more prolonged their vision problems.
I don't remember exactly when I heard about this phenomenon, but it was around the time that Mark Blaxill and I were working on our book, The Age of Autism -- Mercury, Medicine, and a Man-Made Epidemic. In doing research into the history of mercury in medicine, we more or less stumbled on a striking new idea: many of Sigmund Freud's early patients -- critical to the creation of psychoanalytic theory --were in fact mercury poisoned rather than emotionally traumatized.
We wrote about that in Chapter Two of our book, describing the remarkable association between those early patients and background exposure to mercury. In some cases that exposure came when young women were tending to fathers who had contracted syphilis before marriage; this was the heyday of mercury as a cure-all, and some of those men received hundreds of mercury inunctions, or rubs, as so-called treatments. Our theory was that "the caregiver effect" exposed the daughters to the toxin and accounted for their symptoms.
Many of those "hysteria" sufferers had visual disorders, often the constricted visual field that is a prime symptom of mercury poisoning. Others suffered from "face blindness," an inability to recognize close acquaintances.
We concluded there was really no such thing as hysteria, at least in the sense Freud was using it. These were previously healthy individuals whose well-being, both physical and mental, was damaged not by trauma but by a toxin. The implications for psychiatry of this massive misdiagnosis seem kind of significant. (We found connections to mercury in the first families with children diagnosed with autism in 1930s; the implications for autism of this massive misdiagnosis also seem kind of significant.)
So coming across a more or less contemporary case series of women whose sight was impaired, and who were diagnosed with "hysterical blindness," was fascinating. Certainly the trauma they experienced was undeniable, and unspeakable. But did it really explain the vision problems? Were there other scenarios that needed to be ruled out before this exotic, almost poetic, etiology was accepted as fact?
My first hypothesis, given our Freud research, was mercury poisoning. Cambodians have a fish-centric diet, and I wondered if that might explain it. Mercury in fish has been a growing concern, and Cambodians fishing off piers in the polluted Port of Long Beach seemed a possibility. There's also a ubiquitous condiment called fish paste in Camdodian cuisine, and this highly concentrated product seemed like a possible suspect for bolus doses of organic mercury.
Or perhaps just the cheap and plentiful supply of canned tuna, replacing access to a wide variety of wild-caught fish in Cambodia, could explain it.
As I said, this was just a hypothesis, or perhaps even a lesser variation called a hypothesis-generating idea. Those of us who've found ourselves trying to figure out medical mysteries in the absence of honest effort by mainstream science come up with our own set of tests for how likely any given idea might be ("visceral logic" is how I think of my own approach -- do enough dots connect to outline a preliminary theory?). I've seen the scientific method called "guess and test," and whatever fancy procedures get wrapped around it, that seems like a good description. Mainstream medicine sometimes seems to have an anaphylactic allergy to it, though.
Of course, I'm not in a position to test for mercury in fish paste in Long Beach in 1985, and even so, what would it prove to a world wedded to psychiatric explanations of just about any human condition short of a severed limb?
I did have a chance to do hypothesis-testing of a sort when I ended up in Long Beach a while back for an autism conference. I stayed a couple of extra days, and on my first free morning took a cab to the part of Long Beach called Cambodia Town, a thriving hub of food, culture, and shopping. I stopped at a community center, where some Christian missionaries were helping residents improve their English (and perhaps ultimately their religion?). No one there remembered anything about the blindness that afflicted a generation by now once or twice removed.
So I walked down the street to the local library, a classic journalistic backstop, and described my subject to the librarian. She steered me to some books and community publications. Yes, there was plenty of subsistence fishing off polluted piers.
She also introduced me to a friendly, early middle-age Cambodian-American man who was working as a security guard there. As I wrote in a cellphone note to Mark:
"Interesting day. No one remembers that cluster but I did talk to a man who survived the genocide. He and many others developed what is known as chicken blindness in which they became totally blind but only at night. Malnutrition is the cause, apparently lack of vitamin a. He said he got better by eating liver for a month. Malnutrition/starvation seems like a plausible factor in the 'hysterical' cases as well."
That security guard -- "the man who survived the genocide" -- gave me an unforgettable image. Imprisoned as a teenager, he told me, he had watched a guard casually toss a chicken bone on the ground, and he and a dog both dove for it. He was beaten for that by the guard, and the dog got the bone.
In terms of hysteria, we might well ask, what caused the guard's "chicken blindness" -- the trauma of giving up a chicken bone to a dog and being beaten, or malnutrition, with the chicken bone signifying just how hard getting even a morsel to eat could be?
So yes, the Cambodian refugees who relocated to Long Beach had suffered -- and seen -- literally the tortures of the damned. And they were no doubt horribly malnourished over many years. Could diet rather than trauma have created vision problems, including difficulty with light and shadows? Does the fact that the first Cambodian I encountered -- the security guard -- talked about widespread blindness as a result of malnutrition suggest that such a cause needed to be considered before settling on "hysteria." According to my visceral logic, the answer is yes.
I found myself thinking about the Cambodian cluster this week as I read all the coverage for Autism Awareness Month. As you know, psychiatrists first blamed the disorder on bad parents, and now pinpoint bad genes. We who think the environment is the driving cause -- that this is a manmade, medically induced epidemic -- are called cranks and quacks and etcetera and etcetera and etcetera.
I see the same phenomenon in coverage of the mental health of soldiers and vets -- 1 in 5 with mental problems, twice the national average; 22 suicides a day; another shooting at Fort Hood by a soldier on Ambien and who knows what else (my doctor doesn't prescribe Ambien to anyone because she says it blocks REM sleep and eventually makes you crazy). The idea that all the medicines poured into them over years and years could be a factor is still not on the radar.
And back in California, a new cluster of polio-like illnesses is attributed to viruses, never to the increasingly toxic environment and food supply. In New York State, cases of debilitating tics were blamed on the "hysterical" girls themselves. It's time to do better by all of them, and this month is as good a place to start as any.
Dan Olmsted is Editor of Age of Autism.