The Hmong Sudden Death Syndrome

Vang was a former Hmong (Laotian) soldier who settled in Chicago in 1980, as an escapee of the war in Laos. Lang suffered from traumatic memories of wartime destruction, including severe guilt of leaving his brothers and sisters behind when he fled with his wife and child. According to a mental health team, the culture shock created due to moving from a rural Laos to urban Chicago increased Vang's stress even further. He experienced problems almost immediately.

Vang suffered from sleep issues; he was unable to sleep from the first night in his apartment in Chicago. This continued for the next two days, causing him to visit his resettlement worker, Moua Lee, and confess his problems. He confessed that on the first night, he had woken up suddenly, feeling short of breath from a dream in which a cat was sitting on his chest; and that on the second night, a figure which resembled a black dog came to his bed and sat on his chest, causing him to go out of breath quickly and dangerously. On the third night, a tall, white-skinned female appeared in his bedroom and lay on top of him. Her weight caused difficulty in his breathing, and after 15 minutes, the spirit left and he woke up screaming.

Trauma & Culture

Vang's report attracted scientific interest due to around 25 Laotian refugees in the United States dying of what was termed as the Hmong Sudden Death Syndrome. The victims in those cases also experienced symptoms similar to those Vang did: an exhibition of laboured breathing, screaming, and frantic movements. The US Center for Disease Control investigated these deaths and was unable to find a physical cause. They concluded that the deaths were triggered by a combination of the stress of resentment, guilt over having to abandon families in Laos, and Hmong's cultural beliefs of angry spirits.

The authors of Vang's case study concluded that he might have been a survivor of Sudden Death Syndrome. The role of cultural beliefs is suggested by what happened next. Vang went for treatment to a Hmong woman regarded as a shaman. She told him his problems were caused by unhappy spirits and performed ceremonies to release them. Vang's nightmares and breathing problems during sleep ceased afterwards.

Like the cases of voodoo deaths, Vang's case study suggests that cultural stress and beliefs may have a profound influence on physical well-being. This work was followed by other studies on Hmong immigrants and stimulated interest in the relationship between cultural beliefs and health.

Case Studies

The major limitation of a case study is that it is a poor method for determining cause-effect relations. in most case studies, explanations of behaviour occur after the fact, and there is little opportunity to rule out alternative explanations. The fact that Vang's symptoms ended after seeing a shaman might not have anything to do with his cultural beliefs; it could have been pure coincidence, or other changes in his life could have been responsible.

A second potential drawback concerns on the generalisation of findings: will the principles uncovered in a case study hold true for other people or other situations? The question of generalisability pertains to all research methods, but drawing broad conclusions from a case study can be particularly risky. The key issue is the degree to which the case under study is representative of other people or situations.

A third drawback is the possible lack of objectivity in the way data is gathered and interpreted. Such bias can occur in any type of research, but case studies can be particularly worrisome due to them often being based largely on the researcher's subjective impressions. In science, a skeptical attitude is required for claims based on case studies to be followed up by more comprehensive research methods before being accepted. We should adopt similar skeptical views in our daily lives, too.