Culture, Medicine and Psychiatry

, Volume 18, Issue 1, pp 23–59 | Cite as

Ethnomedical pathogenesis and Hmong immigrants' sudden nocturnal deaths

  • Shelley R. Adler


Scores of seemingly healthy Hmong immigrants have died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the role of powerful traditional beliefs in illness causation. In Stockton, California, 118 Hmong men and women were interviewed regarding their awareness of and personal experience with a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranormal encounter acts as a trigger for Hmong SUNDS.


Medical Research Sudden Death Personal Experience Illness Causation Adequate Explanation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Adler, Shelley R. 1991a Sudden Unexpected Nocturnal Death Syndrome among Hmong Immigrants: Examining the Role of the “Nightmare.” Journal of American Folklore 104(411):54–71.Google Scholar
  2. 1991b The Role of the Nightmare in Hmong Sudden Unexpected Nocturnal Sudden Death Syndrome: A Folkloristic Study of Belief and Health. University of California, Los Angeles, doctoral dissertation. Ann Arbor: University Microfilms International.Google Scholar
  3. Adler, Shelley R. 1992 The Role of Supranormal Nocturnal Encounters in Ethnomedicogenic Illness and Hmong Immigrants' Sudden Nocturnal Deaths. Presentation at the American Anthropological Association Annual Meetings in San Francisco, California, December 2–6.Google Scholar
  4. Barney, G. Linwood, and William A. Smalley 1952 Report of Second Conference on Problems in Meo (Miao) Phonemic Structure and Orthography. Unpublished manuscript.Google Scholar
  5. Barney, G. Linwood, and William A. Smalley 1953 Third Report on Meo (Miao): Orthography and Grammar. Unpublished manuscript.Google Scholar
  6. Baron, Roy C., Stephen B. Thacker, Leo Gorelkin, Andrew A. Vernon, William R. Taylor, and Keewhan Choi 1983 Sudden Deaths Among Southeast Asian Refugees: An Unexplained Nocturnal Phenomenon. Journal of the American Medical Association 250:2947–2951.Google Scholar
  7. Baron, Roy C., and Robert H. Kirschner 1983 Sudden Night-time Death among South-east Asians Too. The Lancet 8327:764.Google Scholar
  8. Bernard, H. Russell 1988 Research Methods in Cultural Anthropology. California: Sage Publications.Google Scholar
  9. Bissinger, H. G. 1981 More Cities Report Death Syndrome. St. Paul Pioneer Press. 6 February: F1, 4.Google Scholar
  10. Bliatout, Bruce Thowpaou 1982 Hmong Sudden Unexpected Nocturnal Death Syndrome: A Cultural Study. Oregon: Sparkle Publishing.Google Scholar
  11. Brodsky, Michael A., David A. Soto, Lloyd T. Iseri, Larry J. Wolff, and Byron J. Allen 1987 Ventricular Tachyarrhythmia Associated with Psychological Stress: The Role of the Sympathetic Nervous System. Journal of the American Medical Association 257:2064–2067.Google Scholar
  12. Cannon, Walter 1942, Voodoo Death. American Anthropologist 44:169–181.Google Scholar
  13. Centers for Disease Control 1981 Sudden, Unexpected, Nocturnal Deaths among Southeast Asian Refugees. Morbidity and Mortality Weekly Report 30(47):581–589.Google Scholar
  14. Cerquone, Joseph 1986 Refugees from Laos: In Harm's Way. U.S. Committee for Refugees: Washington, D.C.Google Scholar
  15. Dao, Yang 1982 Why Did the Hmong Leave Laos?In The Hmong in the West, Bruce T. Downing and Douglas P. Olney, eds., pp.3–18. Minneapolis: Southeast Asian Refugee Studies Project and the Center for Urban and Regional Affairs, University of Minnesota.Google Scholar
  16. Dement, William C., Shervert H. Frazier, and Elliot D. Weizman 1984 The American Medical Association Guide to Better Sleep. New York: Random House.Google Scholar
  17. Desan, Christine 1983 A Change of Faith for Hmong Refugees. Cultural Survival Quarterly 7:45–48.Google Scholar
  18. Donnelly, Nancy Dorelle 1989 The Changing Lives of Refugee Hmong Women. University of Washington doctoral dissertation. Michigan: University Microfilms International.Google Scholar
  19. Engel, George L. 1971 Sudden and Rapid Death during Psychological Stress: Folklore or Folk Wisdom? Annals of Internal Medicine 74:771–782.Google Scholar
  20. Feintuch, Burt 1988 The Conservation of Culture: Folklorists in the Public Sector. Lexington: The University Press of Kentucky.Google Scholar
  21. Foster, George M. 1973 Dreams, Character, and Cognitive Orientation in Tzintzuntzan. Ethos 1(1):106–121.Google Scholar
  22. Garrett, W.E. 1974 The Hmong of Laos: No Place to Run. National Geographic 145:78–111Google Scholar
  23. Greene, William A., Sidney Goldstein, and Arthur J. Moss 1972 Psychosocial Aspects of Sudden Death: A Preliminary Report. Archives of Internal Medicine 129:725–731.Google Scholar
  24. Hahn, Robert A., and Arthur Kleinman 1983 Belief as Pathogen, Belief as Medicine: “Voodoo Death” and the “Placebo Phenomenon” in Anthropological Perspective. Medical Anthropology Quarterly 14:3, 6–19.Google Scholar
  25. Hartmann, Ernest 1984 The Nightmare: The Psychology and Biology of Terrifying Dreams. New York: Basic Books.Google Scholar
  26. Heimbach, Ernest E. 1979 White Hmong-English Dictionary. Ithaca: Cornell University Press.Google Scholar
  27. Hendricks, Glenn L., Bruce T. Downing, and Amos S. Deinard, eds. 1986 The Hmong in Transition. Staten Island: Center for Migration Studies of New York; and Minneapolis: The Southeast Asian Refugee Studies Project of the University of Minnesota.Google Scholar
  28. Hishikawa, Yasuo 1976 Sleep Paralysis. In Narcolepsy: Proceedings of the First International Symposium on Narcolepsy, Advances in Sleep Research, vol. 3, Christian Guilleminault, William C. Dement, and Pierre Passouant, eds., pp.97–124. New York: Spectrum Publications.Google Scholar
  29. Holtan, Neal, Dave Carlson, Jean Egbert, Rachel Mielke, and T. Christopher Thao 1984 Final Report of the SUNDS Planning Project. St. Paul, Minnesota: St. Paul-Ramsey Medical Center.Google Scholar
  30. Hoops, Johannes, ed. 1916 Reallexikon der Germanischer Altertumskunde. Strassburg: Karl J. Trubner.Google Scholar
  31. Hufford, David J. 1976 A New Approach to the “Old Hag”: The Nightmare Tradition Reexamined.In American Folk Medicine: A Symposium, Wayland D. Hand, ed., pp. 73–85. Berkeley and Los Angeles. University of California Press.Google Scholar
  32. 1982 The Terror That Comes in the Night. Philadelphia: University of Pennsylvania Press.Google Scholar
  33. 1988 Inclusionism yersus Reductionism in the Study of Culture-bound Syndromes. Book Review. Culture, Medicine, and Psychiatry 12(4):503–511.Google Scholar
  34. Johnson, Charles 1985 Dab Neeg Hmoob: Myths, Legends, and Folktales from the Hmong of Laos. St. Paul, Minnesota: Macalester College.Google Scholar
  35. Jones, Ernest M. 1931 On the Nightmare. London: Hogarth Press.Google Scholar
  36. Kellerman, Henry 1981 Sleep Disorders: Insomnia and Narcolepsy. New York: Brunner/Mazel.Google Scholar
  37. Kirschner, Robert. H., Friedrich A. O. Eckner, and Roy C. Baron 1986 The Cardiac Pathology of Sudden, Unexplained, Nocturnal Death in Southeast Asian Refugees. Journal of the American Medical Association 256:2700.Google Scholar
  38. Kirschner, Robert H., Friedrich A. O. Eckner, Roy C. Baron 1987 Sudden Nocturnal Death in Southeast Asian Refugees. Journal of the American Medical Association 257(11):1473.Google Scholar
  39. Kluge, Friedrich 1960 Etymologisches Wörterbuch der Deutschen Sprache. Berlin: Walter de Gruyter.Google Scholar
  40. Lee, Gary Yia 1981 The Effects of Development Measures on the Socio-Economy of the White Hmong. University of Sydney doctoral dissertation. Unpublished.Google Scholar
  41. Lemoine, Jacques and Christine Mougne 1983 Why Has Death Stalked the Refugees? Natural History 11:12–19.Google Scholar
  42. Lown, Bernard, Richard Verrier, and Ramon Corbalan 1973 Psychologic Stress and Threshold for Repetitive Ventricular Response. Science 182:834–836.Google Scholar
  43. Marshall, Eliot 1981 The Hmong: Dying of Culture Shock? Science 212:1008.Google Scholar
  44. Mather, Cotton 1692 On Witchcraft: Being the Wonders of the Invisible World. Boston: N.p. Reprint as Cotton Mather on Witchcraft. New York: Bell Publishing Co., n.d.Google Scholar
  45. Melles, Ronald B. and Barrett Katz 1988 Night Terrors and Sudden Unexplained Nocturnal Death. Medical Hypotheses 26:149–154.Google Scholar
  46. Meredith, William H., and S. Cramer 1982 Hmong Refugees in Nebraska.In The Hmong in the West, Bruce T. Downing and Douglas P. Olney, eds., pp.3–18. Minneapolis: Center for Urban and Regional Affairs.Google Scholar
  47. Monagan, David 1982 Curse of the Sleeping Death. Science Digest April:36–38.Google Scholar
  48. Morbidity and Mortality Weekly Report 1988 Update: Sudden Unexplained Death Syndrome among Southeast Asian Refugees — United States. 37(37):568–570.Google Scholar
  49. Muecke, Marjorie A. 1983 In Search of Healers: Southeast Asian Refugees in the American Health Care System. The Western Journal of Medicine 139:835–840.Google Scholar
  50. Munger, Ronald G. 1982 Sudden Adult Death in Asian Populations: The Case of the Hmong.In The Hmong in the West: Observations and Reports, Bruce T. Downing and Douglas P. Olney, eds., pp.307–319. Minneapolis: Southeast Asian Refugee Studies Project and the Center for Urban and Regional Affairs, University of Minnesota.Google Scholar
  51. 1985 Sudden Death in Sleep of Asian Adults. University of Washington doctoral dissertation. Ann Arbor: University Microfilms International.Google Scholar
  52. 1986 Sleep Disturbances and Sudden Death of Hmong Refugees: A Report on Fieldwork Conducted in the Ban Vinai Refugee Camp.In The Hmong in Transition, Glenn L. Hendricks, Bruce T. Downing, and Amos S. Deinard, eds., pp.379–398. Staten Island: Center for Migration Studies of New York; and Minneapolis: The Southeast Asian Refugee Studies Project of the University of Minnesota.Google Scholar
  53. 1987 Sudden Death in Sleep of Laotian-Hmong Refugees in Thailand: A Case-Control Study. American Journal of Public Health 77:1187–1190.Google Scholar
  54. Munger, Ronald G., and Marshall G. Hurlich 1981 Hmong Deaths. Science 213(4511):952.Google Scholar
  55. Ness, Robert C. 1978 The Old Hag Phenomenon as Sleep Paralysis: A Biocultural Interpretation. Culture, Medicine, and Psychiatry 2:15–39.Google Scholar
  56. Ornstein, Robert, and Charles Swencionis, eds. 1990 The Healing Brain: A Scientific Reader. New York and London: The Guilford Press.Google Scholar
  57. Otto, Catherine M., Robert V. Tauxe, Leonard A. Cobb, H. Leon Greene, Brian W. Gross, Jeffrey A. Werner, Robert W. Burroughs, Werner E. Samson, Douglas Weaver, and Gene B. Trobaugh 1984 Ventricular Fibrillation Causes Sudden Death in Southeast Asian Immigrants. Annals of Internal Medicine 100:45–47.Google Scholar
  58. Otto, Rudolf 1936 Das Heilige. Munich: N.p.Google Scholar
  59. Parkes, J.D. 1985 Sleep and Its Disorders. London: W. B. Saunders.Google Scholar
  60. Parrish, Roy Gibson 1988 Death in the Night: Mysterious Syndrome in Asian Refugees. In 1989 Medical and Health Annual, E. Berstein and L. Tomchuck, eds., pp.286–290. Chicago:Encyclopedia Britannica.Google Scholar
  61. Parrish, R. Gibson, Myra Tucker, Roy Ing, Carol Encarnacion, and Mark Eberhardt 1987 Sudden Unexplained Death Syndrome in Southeast Asian Refugees: A Review of CDC Surveillance. Morbidity and Mortality Weekly Review 36:43–53.Google Scholar
  62. Powell, Nicholas 1972 Fuseli: The Nightmare. New York: The Viking Press. Profiles of the Highland Lao Communities in the United States Washington, D. C.: United States Department of Health and Human Services.Google Scholar
  63. Pyle, Jack 1981 Death Stalking Refugees. The News Tribune (Tacoma, Washington) 16 April:C1.Google Scholar
  64. Quincy, Keith 1988 Hmong: History of a People. Cheney: East Washington University Press.Google Scholar
  65. Rahe, Richard H., Matti Romo, Linda Bennett, and Pentti Siltanen 1974 Recent Life Changes, Myocardial Infarction, and Abrupt Coronary Death. Archives of Internal Medicine 133:221–228.Google Scholar
  66. Ranke, Kurt 1977 Enzyklopädie des Marchens. Volumes 1ff. Berlin.Google Scholar
  67. Rechtschaffen, Allan, and William C. Dement 1969 Narcolepsy and Hypersomnia.In Sleep: Physiology and Pathology, Anthony Kales, ed., pp. 119–130. Philadelphia and Toronto: J. B. Lippincott.Google Scholar
  68. Refugee Health Issues Quarterly 1989. Update: Sudden Unexplained Death Syndrome Among Southeast Asian Refugees. 4(2):1, 3.Google Scholar
  69. Riley, Terence C. 1985 Clinical Aspects of Sleep and Sleep Disturbances. Boston: Butterworth Publishers.Google Scholar
  70. Röhrich, Lutz 1973 Probleme der Sagenforschung. Freiburg im Breisgau: Deutsche Forschungsgemeinschaft.Google Scholar
  71. Roscher, Wilhelm Heinrich 1979 Ephialtes: A Pathological-Mythological Treatise on the Nightmare in Classical Antiquity. Translated from the German by A.V. O'Brien. In Pan and the Nightmare, Wilhelm Heinrich Roscher and James Hillman, pp.1–81. Irving, Texas Spring Publications.Google Scholar
  72. Scheper-Hughes, Nancy, and Margaret M. Lock 1987 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly (ns) 1:6–41.Google Scholar
  73. Simons, Ronald C., and Charles C. Hughes, eds. 1985 The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest Dordrecht: D. Reidel.Google Scholar
  74. Sturlason, Snorri 1932 Heimskringla or the Lives of the Norse Kings. Edited by Erling Monsen. Translated by A. H. Smith. Cambridge: W. Heffer and Sons.Google Scholar
  75. Takeuchi, T., A. Miyasita, Y. Sasaki, M. Inugami, and K. Fukuda 1992 Isolated Sleep Paralysis Elicited by Sleep Interruption. Sleep 15(3):217–225.Google Scholar
  76. Tatsanavivat, Pyatat, Aroon Chiravatkul, Virat Klungboonkrong Supot Chaisiri, Lerdchai Jarerntanyaruk, Ronald G. Munger, and Sastri Saowakontha 1992 Sudden and Unexplained Deaths in Sleep (Latai) of Young Men in Rural Northeastern Thailand. International Journal of Epidemiology 21(5):904–910.Google Scholar
  77. Thompson, R. Campbell 1971 Semitic Magic: Its Origin and Development. New York: Ktav Publishing House.Google Scholar
  78. Tobin, Joseph Jay, and Joan Friedman 1983 Spirits, Shamans, and Nightmare Death: Survivor Stress in a Hmong Refugee. American Journal of Orthopsychiatry 53:439–448.Google Scholar
  79. Trachtenberg, Joshua 1984 Jewish Magic and Superstition: A Study in Folk Religion. New York: Atheneum.Google Scholar
  80. Vang, Lue, and Judy Lewis 1984 Grandmother's Path Grandfather's Way. San Francisco: Zellerbach Family Fund.Google Scholar
  81. Ward, Donald 1977 The Little Man Who Wasn't There: Encounters with the Supranormal. Fabula: Journal of Folklore Studies 18:213–225.Google Scholar
  82. 1981 The German Legends of the Brothers Grimm. London: Millington Books.Google Scholar
  83. Westermeyer, Joseph 1981 Hmong Deaths. Science 213:952.Google Scholar
  84. 0 1987 Prevention of Mental Disorder among Hmong Refugees in the U.S.: Lessons from the Period 1976–1986. Social Science and Medicine 25(8):941–947.Google Scholar
  85. 0 1988 A Matched Pairs Study of Depression among Hmong Refugees with Particular Reference to Predisposing Factors and Treatment Outcome. Social Psychiatry and Psychiatric Epidemiology 23:64–71.Google Scholar

Copyright information

© Kluwer Academic Publishers 1994

Authors and Affiliations

  • Shelley R. Adler
    • 1
  1. 1.Division of Medical Anthropology Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco

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