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94 The Night-mare, Traditional Hmong Culture, and Sudden Death “Hmong refugees do not seek new lives, they seek the same lives in a new location, and where possible they use their new opportunities to bolster preexisting social conceptions.” —Nancy Donnelly (1994, 184) Sudden Death and the Night-mare: Is There a Connection? Since the first reported case, which occurred in 1977, more than 117 Southeast Asians in the United States have died from the disorder that is now known as SUNDS, the Sudden Unexpected Nocturnal Death Syndrome. The sudden deaths have had an unusually high incidence rate among Laotians, particularly Hmong refugees.1 All but one of the victims have been men; their median age is thirtythree ; and the median length of time that they lived in the United States before their death is seventeen months (Parrish 1988). No one had complained of illness or discomfort before going to bed; all were considered by family members to have been in good health. Occasionally, the deaths were witnessed by a relative who had been awakened by the sound of gasping or moaning, but the sleeper would die within a minute or two. Most victims, however, were unresponsive when they were found and could not be revived. The deaths occurred with alarming frequency; at their peak in 1981–82, the rate of death from SUNDS among twenty-five- to forty-four-year-old Hmong men was 92 per 100,000 (Baron and Kirschner 1983), a figure equivalent to the combined rate of the five leading causes of natural death among men in the United States in the same age group. Despite numerous studies of SUNDS—exploring such diverse but potentially relevant issues as electrolytes and circadian cycles (Holtan et al. 1984), genetics (Marshall 1981; Munger and Hurlich 1981),2 heart disease (Kirschner, Eckner, and Baron 1986; Otto et al. 1984), mental health (Westermeyer 1981), metabolic problems (Bliatout 1982), nutrition (American Refugee Committee 1989), sleep apnea (Holtan et al. 1984), and toxicology (Bissinger 1981; Bliatout 1982; Holtan et al. 1984; Pyle 1981)—medical scientists were not able to determine exactly what was causing the sudden nocturnal deaths. The most plausible of the 5 VVVVVVVVVVV hypotheses implicated a problem with the heart’s electrical conduction system, but a 1988 report from the Centers for Disease Control underscored the limitations of even this possibility: “Only at night, in times of unusual stress, and possibly in conjunction with other, as yet undefined, factors are these people at risk of developing abnormal electrical impulses in the heart that result in ventricular fibrillation and sudden death” (Parrish 1988). In the summer of 1984, a group of epidemiologists gathered at the St. PaulRamsey Medical Center (now Regions Hospital) in Minnesota to propose methods for studying SUNDS and to formulate recommendations for public health officials responding to the crisis. People at high risk for SUNDS were defined as “those who fit the demographic characteristics and have one of the following signs or three of the following symptoms”: SIGNS 1. breathing pauses in sleep 2. seizures or muscle spasms during sleep 3. loud snoring, gasping, or choking sounds during sleep 4. cyanosis during sleep 5. unarousability from sleep SYMPTOMS 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 5. a disturbance in sensation (auditory, visual, or tactile) (Holtan et al. 1984, 11) The symptoms of SUNDS-related events clearly mirror the features of the nightmare as it has been known across cultures and throughout history. The signs are more difficult to interpret, but interrupted breathing and choking sounds might be traditionally viewed as the consequence of an attack by a pressing spirit. Muscle spasms, cyanosis (skin taking on a bluish color due to insufficient oxygen in the blood), and “unarousability” are not consistent with a typical nightmare attack and may more accurately reflect a later stage of SUNDS itself. The parallels between epidemiologist-reported symptoms and those experienced by night-mare sufferers themselves prompt a critical question: Does the existence of a distinctive symptom constellation suggest a link between the night-mare encounter and Hmong SUNDS, or is it simply an artifact of misinterpretation on the part of scientists unfamiliar with the characteristics and distribution of the night-mare? At a meeting of the epidemiology discussion group of the SUNDS Planning Project, one researcher suggested that “those persons who have described the...

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Additional Information

ISBN
9780813552378
Related ISBN
9780813548852
MARC Record
OCLC
778339945
Pages
182
Launched on MUSE
2014-01-01
Language
English
Open Access
No
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