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Essay: SUNDS in the Hmong people

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  • Published: 15 October 2019*
  • Last Modified: 29 September 2024
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Introduction

The Hmong are of an Asian ethnic-group that is made up of individuals from multiple areas in multiple countries such as Laos, the Southern region of China, parts of Vietnam and
Thailand (Munger, 1987).  The distribution of the Hmong people is widespread in the Western world, due to the civil unrest that has torn through the earlier listed countries (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983). The Hmong have been specifically prone to a condition known as Hmong Sudden Death Syndrome, which is a form of Sudden Unexpected Nocturnal Death Syndrome (SUNDS) that primarily targets Southeast Asian peoples (Adler, 1994).  The Hmong populations in which this SUNDS occurs, is not limited geographically as it pervades throughout the entire Hmong population (Adler, 1994; Munger, 1987).  The medical research into this phenomena has not primarily been able to stamp a satisfactory or concrete cause of SUNDS in the Hmong people (Adler, 1994).
HISTORY & SYMPTOMS
History
The first case of Hmong Sudden Death Syndrome was documented in July 1977; since then records of deaths, statistics, and circumstances preluding to the syndrome have been better tracked (Adler, 1994).  This condition is peculiar in its own right because it is noted to affect individuals that are a majority of young individuals up to persons of middle-age; of which most are deemed healthy for the most part (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983).  It has been observed that Hmong Sudden Death Syndrome overwhelming afflicts males (Adler, 1994; Munger, 1987), yet, there are female-based cases on record (Munger, 1987).
In 1981-1982, deaths in Laotian-Hmong men residing in the United States reached a startling figure of 92 individuals out of 100,000 succumbing to the affliction; a deadly figure that was equal to the total of the five leading natural male deaths in the United States (Munger, 1987).  The average age of a victim of Hmong SUNDS, relating to the last context, was 33 years (Adler, 1994; Munger, 1987).  According to the Centers for Disease Control in 1988 (as cited in Adler, 1994), the average period of time spent in the United Stated of the deceased was 17 months (Adler, 1994). It is not difficult to see why this syndrome is under scrutiny to help discover in-depth, the cause or combination of causes.
Symptoms
According to the 1984 Final Report of the SUNDS Planning Project by Holton and Colleagues (as cited in Adler, 1994), those who fall into the bounds of being at-risk of Hmong SUNDS have the following temporary night-time occurrences:
(1) a sense of panic or extreme fear, (2) paralysis (partial or complete), (3) a sense of pressure on the chest, (4) a sense that there is an alien being (animal, human, or spirit) in the room, [and] (5) a disturbance in sensation (auditory, visual, or tactile). (Holton et al., 1984 as cited in Adler, 1994)
Many of these symptoms seem to be attributed to anxiety and stress that accumulate then manifest in the form of these occurrences (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983). Individuals that experience “seizure-like” symptoms during rest need to observed medically that have the necessary equipment to resuscitate a person (Tobin & Friedman, 1983). The moderate amount of medical analysis that has been done on SUNDS has leaned on the probability of an irregular cardiac conduction system could influence cardiac arrest (Adler, 1994; Munger, 1987); it is in the realm of possibility that the deceased also had a cardiac arrhythmia (Adler, 1994; Munger, 1987).  The evidence that medical examiners have been able to piece together points to the most likely cause of death being attributed to a common ventricular arrhythmia called, “ventricular fibrillation” (Alder, 1994; Munger 1987).  It should be noted that ventricular fibrillation may occur primarily in Western population to cardiovascular disease; in the case Hmong SUNDS, it was primarily absent in examination (Adler, 1994; Munger 1987).
CASE STUDY
There was a 1978 case study done on a male individual by the name of, Vang Xiong, a former Hmong soldier that had relocated to Chicago at the age of 22 (Tobin & Friedman, 1983).  Tobin & Friedman (1983) go on to explain that Xiong’s family had moved into a new apartment after a relatively decent start to life in America.  Vang soon told his resettlement worker that he had awoken that night out of breath after from having a dream of a cat on top of his chest (Tobin & Friedman, 1983). Tobin & Friedman (1983) also went on to explain about the second night, it was the same occurrence except the animal was a black dog that he couldn’t budge off of himself.  Vang then went on to describe the worst incident on the third night: a tall, pale-skinned female spirit had laid over his chest and he couldn’t move at all as he labored to breathe (Tobin & Friedman, 1983).  Eventually, Tobin & Friedman (1983) state that a Hmong Shaman, Mrs. Thor, visited the Xiong family to assist in helping the family with their problem.  It is explained by the authors that a ritual was conducted by the shaman that began with lit candles and her chanting for approximately an hour. At this time, she ascertained from her spirit that the figures that had caused Vang trouble, were the former apartment residents that left without taking their souls (Tobin & Friedman, 1983).  The shaman cut a cloak of newspaper that was then ceremoniously burned to dispel the spirits.  Vang then had to crawl “through a hoop, and then between two knives”; he was told that these actions would prevent spirits from following him (Tobin & Friedman, 1983).
Essentially, it is stated that the ritual was helped cure the severe symptoms of Hmong SUNDS that Vang Xiong was experiencing in his new apartment.  According to Tobin & Friedman (1983), the main emphasis is that Vang Xiong, like many Hmong, believed that dreams and nightmares are manifestations of evil spirits that prey on vulnerable people “through sins of omission or commission”.  This revelation, in conjunction with the overwhelming amount of cases being male, narrows in on the best view of the mental state this cross-section of the population.  The most complete conclusion can be attributed to Adler (1994), which is that male Hmong view failures to satisfy their religious obligations as cause for retribution by the spirits by manifesting into these symptoms.  Tobin & Friedman (1983) also contribute a significant part of the puzzle in the form of revealing Vang Xiong’s feelings of guilt and self-loathing at escaping safely as a refugee from Laos when others he knew did not.
SIMILARITIES TO EXISTING DISORDER
The most similar existing psych disorder that Hmong Sudden Death Syndrome mirrors the most would be Post-Traumatic Stress Disorder or commonly referred to as the abbreviation, PTSD.  The similarities begin with how an individual develops feelings of anxiety and paranoia, which may lead to negative emotional responses like feeling extreme guilt; it may be linked to traumatic events.  It should be noted that PTSD sufferers also often have problems sleeping and can end up displaying dissociative behaviors.  Hmong SUNDS prone individuals have a high risk of developing sleep issues that include insomnia, dreams and nightmares (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983).  A contrast that Hmong SUNDS presents is that it has to do more with religious beliefs during sleep, such as in the form of a spirit in a nightmare and sleep paralysis interpreted as an attack (Adler, 1994; Tobin & Friedman, 1983).  Another difference that sticks out is that there isn’t a major amount of evidence of avoidance behavior that typical PTSD sufferers experience when it comes to analyzing Hmong SUNDS.

Conclusion

If there is to be more information to be learned about Hmong Sudden Death Syndrome, it would have to focus on the prevalence of SUNDS spread across multiple generations.  If my assertions are correct that this syndrome is a founded in the same roots as Post-Traumatic Stress Syndrome, can handling individuals with risk factors with PTSD treatments like anti-anxiety drugs or social therapies help? Is there a biological factor at play that leaves Southeastern Asians more affected by the levels of stress hormones within their bodies?  As generations become more acculturated into the societies they are part of, will Hmong Sudden Death Syndrome become more of a memory?
After interpreting the evidence, I believe that Hmong Sudden Death Syndrome seems to be more of a stress-disorder, if not PTSD that’s been refracted into the prism of Hmong culture.  In all of the articles, there were major contributors of stress for individuals such as being displaced as a refugee of war and having to cope with the major disruptions that were occurring in relation to their lives (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983).  Males had a compounded amount of stress due to having to juggle adhering to their duties in the Hmong faith with the previous disruptions stated.  I strongly believe this led to the lopsided percentage towards males becoming vulnerable to this syndrome that is shown in the evidence (Adler, 1994; Munger, 1987; Tobin & Friedman, 1983).  I believe these stressors take their toll on an already disadvantaged cardiovascular system in the individuals that end up becoming part of the fatal SUNDS statistics (Adler, 1994; Munger, 1987).

References

Adler, S. R. (1994). Ethnomedical pathogenesis and Hmong immigrants’ sudden nocturnal deaths. Culture, Medicine & Psychiatry, 18(1), 23-59. Retrieved from http://search.ebscohost.com.ezproxy.morton.edu/login.aspx?direct=true&db=a9h&AN=9410213936&site=ehost-live
Munger, R. G. (1987). Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study. American Journal of Public Health, 11(9), 1187-1190. doi:10.2105/AJPH.77.9.1187.
Tobin, J. J., & Friedman, J. (1983). Spirits, shamans, and nightmare death: Survivor stress in a Hmong refugee. American Journal Of Orthopsychiatry, 53(3), 439-448. doi:10.1111/j.1939-0025.1983.tb03388.x

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