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.

Sleepwalking and Consciousness

What is sleepwalking, and how can people do things that are impossible to do while being asleep? Some people sleepwalk to their kitchen to eat food and go back to sleep with no recollection of it in the morning.

Sleepwalking and Crime

There was a case where a man had driven to his mother-in-law's house and killed her and her husband. While driving back home, he had woken up in the car with a bloody knife. Realizing that something had badly gone wrong, he handed himself to the police with the knife, but with no recollection of what had happened—or maybe he did and used sleepwalking as a defence. He was acquitted of murder.

In another case, a man killed a prostitute and set fire to a brothel. Later, he was acquitted on grounds of sleepwalking. Sleepwalking may be real in some cases, but it’s the perfect defence for murder. There were other incidences, one where a couple would sleepwalk to the kitchen and eat raw bacon. In another, a woman would consume salted sandwiches, buttered cigarettes, and large quantities of peanut butter, butter, salt, and sugar. Once, she had woken up while trying to open a bottle of cleaning agent to drink. These individuals usually have no recollection of what happened while they were asleep. The empty packages and half-eaten food, though, made it obvious that something was amiss.

According to my mother, two of my brothers used to sleepwalk when they were very young. Once, one of them had even almost walked off the balcony. If my mother hadn't woken up, he would have fallen. My son used to sit on the bed and talk in his sleep, and sometimes even try to walk out. On a few occasions, he spoke of the One Ring (from The Lord of The Rings) and even looked for it under his pillow—though he didn’t really recall anything in the morning. As I was a light sleeper since my son was born, I would always wake up for the slightest sound, preventing him from walking out.

How can a person sleepwalk to the kitchen and prepare food and eat in their sleep, and how can a person drive while they are asleep and then commit murder, too? Why don't you fall off your bed at night as you are unaware of your many postural shifts as you sleep? Maybe it's because part of you knows where the edge of the bed is. Have you ever been engulfed in thought and spaced out while driving and suddenly snapped out with no recollection of the number of miles you have driven? This means that though you were conscious, you were still focused inward, and a part of you without conscious awareness kept track of the road, controlling your hand movements at the wheel.

The Puzzle of Consciousness

According to philosopher David Charmer, consciousness "is, at once, the most familiar and most mysterious thing in the world. These mysteries range from a normal state of awakening, sleep and dreams, drug-induced experiences, and beyond.”

But what exactly is consciousness, and how does it arise in our brain? In the 1800s, when psychology was founded, it’s “great project” was to unravel some of the puzzles of consciousness. This interest waned in the mid 20th century due to the dominance of Behaviourism, but the resurgence of cognitive and biological perspectives has led us to rethink the longstanding conceptions of the mind.

In psychology, consciousness is often defined as a moment-to-moment awareness of ourselves and our environment. Among its characteristics, consciousness is subjective and private: others cannot directly know what reality is for you, nor can you directly enter into their experience.

Dynamic throughout each day, we drift in and out of various states. Moreover, through stimuli, we are aware of constant change; we typically experience consciousness as a continuously flowing stream of mental activity, rather than as disjointed perceptions and thoughts. Self-reflective and central to our sense of self, the mind is aware of its consciousness. Thus, no matter what your awareness is focused on, a lovely sunset or an itch on your back, you can reflect on the fact that you are the one conscious of it.

Finally, consciousness is intimately connected with the selective attention process. It consists of the selection of some details and the suppression of the rest due to the urgency of attention. Selective attention is the process which focuses on the awareness of some stimuli to the exclusion of others. For example, if the mind is a theatre of mental activity, the consciousness reflects what’s illuminated at the moment; such as the bright spot on the stage, and the selective attention in the spotlight, or the mechanism behind it.

States of Consciousness

Scientists studying consciousness must operationally define private inner states in terms of measurable responses. Self-report measures ask people to describe their inner experiences—they offer the most direct insight into a person's subjective experiences, but aren't always variable or possible to obtain. Most of us do not speak while we sleep; nor can we fill our self-report questionnaires. Much of what occurs within our brains is beyond conscious access. You don't consciously perceive the brain process which lulls you to sleep, awakens you, or regulates your body temperature; and, although you are aware of your thoughts, you're unaware of the brain’s process of creating them.

According to Freud's proposal a century ago, the human mind consists of three levels of awareness. The conscious mind contains thoughts and perceptions of current awareness. Preconscious mental events are outside current awareness, but can be easily recalled under certain conditions. For instance, when someone mentions a friend you haven't thought about for years, you become aware of pleasant memories.

Unconscious events cannot be brought into conscious awareness under ordinary circumstances. Freud proposed that some unconscious content, such as unacceptable sexual and aggressive urges, traumatic memories, and threatening emotional conflicts, are repressed—kept out of conscious awareness due to the possibility of it arousing anxiety, guilt, or other negative emotions.

Behaviourists criticized Freud's ideas as they sought to explain behaviour without invoking conscious mental processes, much less unconscious ones. Cognitive psychologists and many contemporary psychodynamic psychologists, too, take issue with specific aspects of Freud's theory. According to psychodynamic psychologist Drew Westen, many aspects of Freud's theory are, indeed, out of date, and should be. Freud died in 1939, and he was slow to undertake further revisions. However, research supports Freud's general premise: that unconscious processes can affect behaviour.

The Decay of Memory

Decay Theory

Information in sensory memory and short-term memory decays quickly with time, but does long term memory decay as well? An early explanation for forgetting was Decay Theory, which proposed that as time passed and being disused, long-term physical memory traces in the nervous system can fade away. But Decay Theory soon fell into disfavour as scientists were unable to locate neither physical memory traces nor measure physical decay.

However, of recent decades, scientists have begun unravelling the manner in which neural circuits change with the formation of a long-term memory formation, sparking new interests in examining the way these changes might decay over time.

Unfortunately, Decay Theory’s prediction of; the longer the time interval of disuse between learning and recall, the less should be recalled; is problematic. For example, some professional actors tend to display perfect memory for words last used by them on stage two years ago despite having moved on to new acting roles and scripts.

Moreover, when research participants learn a list of words or a set of visual patterns and are retested at two different times, they, at times, recall material during the second resting that they were unable to remember during the first. This phenomenon, called Reminiscence, seems inconsistent with the concept that a memory trace decays over time. To sum up, scientists still debate the validity of Decay Theory.

Motivted Forgetting

Psychologists propose that people, at times, are consciously or unconsciously motivated to forget. According to Sigmund Freud, it was often observed that during therapy sessions, his patients remembered long-forgotten traumatic or anxiety-arousing events. For example, one of his patients suddenly remembered with great shame such an event in which she, while standing beside her sister's coffin, thought: "Now my brother-in-law is free to marry me."

Freud's conclusion was that the thought was so shocking and anxiety-arousing that the woman had repressed it and pushed it down into her unconscious mind, and left it there to remain until it was later uncovered during a therapy session. Repression is a motivational process which protects us by blocking the conscious recall of anxiety-arousing memories.

The concept of repression is controversial, with some evidence supporting it while others disreputing it. People do tend to forget unpleasant events—even traumatic events—yet they can forget very pleasant ones as well. If a person can't recall a negative experience, is it due to repression or to normal information processing failures? Overall, it has been difficult to demonstrate experimentally that a special process akin to repression is the cause of memory loss in the case of anxiety-arousing events.

Prospective Memory

Have you ever forgotten things like mailing a letter, turning off your oven, purchasing a thing you need from the market, or keeping an appointment? In contrast to Retrospective Memory, which is a reference to events of the past, Prospective Memory concerns remembering to perform an activity in the future. That individuals forget to do things as often as they do is interesting, because prospective memory typically involves little content.

Often we need only to recall that we must perform an event-based task ("Remember to mail the letter on your way home" or "Remember to buy milk when you are at the supermarket") or a time-based tasks ("Remember to take your medication at 5:00 pm" or "Remember to keep your doctors appointment at 2:00 pm").

Successful prospective memory, however, draws on cognitive abilities such as planning and allocation of attention while performing other tasks.

During adulthood, do we become increasingly absentminded about remembering to do things, as suggested by a common stereotype? Numerous laboratory experiments support this view. Typically, participants are asked to perform a task requiring their ongoing attention while trying to remember to signal the experimenter at certain time intervals or whenever specific events take place.

Older adults, in general, tend to display poorer prospective memory, especially when the signalling is time-based. However, when prospective memory is tested outside the laboratory using tasks such as simulated pill-taking, healthy adults in their 60s to 80s often perform as well as—or even better than—adults in their 20s. Perhaps older adults feel more motivated to remember in such situations, or maybe they rely more on habit and on setting up of a standard routine.

Amnesia

As  H.M.'s case illustrates, the most dramatic instances of forgetting occur in amnesia. The term Amnesia is commonly referred to as memory loss due to special circumstances such as brain injury, illness, or psychological trauma. However, as we'll see shortly, there is one type of amnesia experienced by everyone.

Amnesia takes several forms: Retrograde Amnesia represents memory loss for events that took place sometime before the onset of amnesia. For example, H.M.'s brain operation, which took place at age 27, caused him to experience mild memory loss for events in life that had occurred during the preceding year or two. For example, when he was 25 to 26 years old.

Football players experience retrograde amnesia when they are knocked out by a concussion; they regain consciousness and cannot remember the events that had occurred just before being hit.

Anteretrogade Amnesia refers to memory loss for events that occur after the initial onset of amnesia. H.M.'s brain operation and, pratricularly the removal of much of his hippocampus, produced severe anterograde amnesia, robbing him of the ability to consciously remember new experiences and facts.

Similarly, the woman whose hand was pinpricked by Swiss psychologist Edouard Claparède during a handshake also suffered from anterograde amnesia; moments later, she could not consciously remember the episode. But, unlike HM's anterograde amnesia, hers was caused by Korsakoff's Syndrome, which can result from chronic alcoholism. It may also cause retrograde amnesia.

Personality Disorders: Causal Factors of BPD

The cause of Borderline Personality Disorder (BPD) is not clear; but according to research, genetics, brain structure and function; as well as environmental, cultural, and social factors; play a role or may increase the risk of developing the disorder. People with BPD tend to have chaotic personal histories marked by interpersonal strife, abuse, and inconsistent parenting. This history, at times, may reflect their earliest memories (childhood memories).

In a study conducted with those with BPD and healthy participants, the two parties were asked to describe their earliest life memories. When the contents of the research were analyzed, researchers discovered that individuals suffering from Borderline Personality Disorder recalled times they had been treated in a malevolent manner six times more than the other party did. Furthermore, the individuals suffering from BPD had also viewed potential helpers as far less helpful to them.

Many BPD patients' parents are described as abusive, rejecting, and non-affirming; and some theorists suggest that an early lack of acceptance by their parents may cripple their self-esteem and lead to a clinging dependency as well as an inability to cope with separation. As they mature, the behaviours of these individuals tend to evoke negative reactions and rejections from others, which causes them to affirm a sense of worthlessness and a view of the world as being wicked towards them.

Not everyone suffering from Borderline Personality Disorder experiences all these symptoms; some may experience just a few of them, while others experience all of the symptoms. BPD patients may feel distressed by minor separations from the people whom they feel close to (even as simple as a business trip, or visiting a sick relative or friend). The severity and frequency of these symptoms depend on the individual, and his or her illness.

Psychological factors

Psychoanalysts Kernberg and Caligor's focus was on the dramatic changes exhibited by individuals with BPD, in their relationships with other people. Their sudden and vitriolic shifts from extreme love and clinging dependence to intense hate or feelings of abandonment, is a reflection of cognitive process called Splitting: the failure in interrogating negative and positive aspects of another's behaviour (for example, a parent who is mostly accepting but at times, voices disapproval) into a coherent whole.

This may result in BPD patients reacting as if the other person has two separate identities: one deserving of love; and the other, of hatred. Whichever of these seemingly independent images such an individual is reacting to at the moment determines how they relate or feel. Together with severe problems in emotional control, splitting makes for chaotic and unpredictable relationships in such individuals.

Biological factors

Biological factors also seem to play a part in this disorder (Depue & Lenzenweger). Close relatives of BPD individuals, such as siblings and parents, have five times more likelihood of having the disorder than those in the general population with the disorder (Torgerson). The impulsivity and emotional explosiveness of BPD individuals may also be a reflection of some biological abnormality in neurotransmitter systems, or areas of the brain that contribute to emotional self-regulation (Gurvitz).

It seems to be entirely possible that BPD reflects an interaction between biological factors and early history of trauma, rejection, as well as psychological and/or physical abandonment. Sociocultural factors also may contribute to the emergence of the disorder. Cases of Borderline Personality Disorder seem to be more prevalent in rapidly-changing, unstable societies, leaving some of its members with a sense of emptiness, problems with identity, and fear of abandonment.

Although individuals with BPD are said to have experienced traumatic events such as abuse, abandonment, or adversity during childhood, it doesn't necessarily mean that all such individuals would develop the disorder, although it is likely. And even though biological factors do contribute to the development of Borderline Personality Disorder, it doesn't necessarily mean such persons will get the disorder. Moreover, persons with no family history of the disorder could get the disorder nevertheless.

Diagnosis and Treatment

Borderline Personality Disorder was viewed as a difficult disorder to treat in the past, but with newer evidence-based treatment options, BPD patients are able to live better lives with fewer or milder symptoms, as well as improvements in the quality of life. It is important for patients of the disorder to receive specialized treatment from an appropriately-trained provider. Other types of treatment, or treatment provided by doctors or therapists who aren't properly trained, may not benefit these individuals.

It takes time for BPD symptoms to improve, once the treatment is begun; and it depends on many factors, so it is important for such individuals and their loved ones to be patient and to receive appropriate support during the treatment. A licensed mental health professional would be able to diagnose this disorder by; completing a thorough interview, which includes a discussion on symptoms; performing a thorough medical exam in order to rule out other possible causes of symptoms; as well as inquiring about family medical history, including any history of mental illness.

Borderline Personality Disorder may often occur with other mental disorders and hence, co-occurring disorders may make it difficult to diagnose and treat BPD, especially when symptoms of other disorders tend to overlap with it. For example, individuals with BPD may be more likely to experience symptoms of depression, anxiety disorders, Bipolar Disorder, eating disorders, and substance abuse disorders as well. According to studies, individuals who do not receive adequate treatment have a likelihood of developing other chronic mental or physical illnesses, and are more likely to fail in healthy lifestyle choices. They are also at high risk of self-harm and suicide.

Medication is not typically used for BPD patients as the benefits are unclear, but medications may be provided to treat other conditions associated with the disorder, such as mood swings, depression, and other co-occurring disorders. Treatment may be needed from more than one medical professional and medication could cause different side-effects, which need to be discussed with the medical practitioner. Some patients may be severely affected by the disorder and need intensive care, while others may be able to do with just outpatient treatment with no need for hospitalization.

Anxiety and Somatoform

Anxiety inferred

Anxiety disorders are usually considered to involve anxiety and stress reactions which are vividly experienced by people who suffer from such conditions, and they are often observable. However, in certain other conditions, the underlying anxiety is largely inferred or assumed to be only present rather than being expressed outward.

For example, in somatoform and dissociative disorders, the person affected may not consciously feel anxious because the function of the disorders is to protect the person involved from strong psychological conflict. According to the beliefs of psychodynamic theorists, whatever may be the distress experienced by the person in such disorders, it is less stressful than the underlying anxiety it is being defended against itself.

Somatoform Disorders

Somatoform disorders involve physical complaints or disabilities suggestive of a medical condition but not present with a biological cause and are not voluntarily produced by the patient. People with hypochondriasis become unduly alarmed about any given physical symptom they feel is convincing them of being seriously ill or about to be. People who suffer from pain disorders experience intense pain that is either out of proportion to whatever medical condition they presume to have for which physical basis is unfounded.

Somatoform disorders differ from psychological disorders in which psychological factors cause or contribute to actual medical conditions such as asthma, migraine headaches, hypertension (chronic high blood pressure), cardiac problems, and peptic ulcers. For example, in a person with a peptic ulcer, stress can produce an outpour of peptic acid, causing an actual lesion in the stomach wall resulting in pain, which is caused by actual physical damage. In somatoform disorders, however, no physical basis for pain can be found.

Conversion Disorder

Conversion disorder may be the most fascinating somatoform disorder, in which serious neurological symptoms such as paralysis, blindness, or loss of sensation suddenly occur. Electrophysiological recordings and brain-imaging of such patients indicates that sensory and motor pathways in the brain are intact. People with conversion disorder often exhibit la belle indifference, which is a strange lack of concern of one's symptoms and its implications.

In some cases, the complaint by the patient themselves is psychologically impossible. An example of this is glove anaesthesia, in which a person loses all sensations below the wrist. The hand is served by nerves, which also provide sensory input to the arm and wrist, making glove anaesthesia anatomically impossible.

Trauma-induced Blindness

Even though psychogenic blindness is rare in the general population, researchers have discovered the largest-known civilian group of people in the world with trauma-induced blindness. These people were refugees who had escaped from Cambodia and had later settled in California. They are survivors of the killing fields of Cambodia who were subjected to unspeakable horror at the hands of the Khmer Rouge in the years that followed the Vietnam War.

More than a 150 of these people were functionally blind, even though their eyes appeared intact and electrophysiological monitoring showed stimuli registered to their visual cortex. Many of them reported that the blindness came on suddenly after they witnessed traumatic scenes of murder, meaning this was a psychological manifestation to past trauma.

Underlying Conflict

According to Freud, conversion symptoms are a symbolic expression of an underlying conflict which aroused a tremendous amount of anxiety, causing the ego to keep the conflict in the unconscious, thereby converting the anxiety into a physical symptom. For example, in one of Freud's cases, a young woman who was forced to care for her hostile, verbally abusive, and unappreciative father, had suddenly developed paralysis in her arm. According to Freud, this had occurred when her repressed hostile impulses threatened to break through and caused her to strike her father with that arm.

A combination of psychological and biological vulnerabilities may cause a person to have a predisposition to somatoform disorders. Somatoform disorders tend to run in families, but it isn't clear whether it's a reflection of the role of genetic factors, environmental learning, and social reinforcement for bodily symptoms or both.

Cultural Influence

In addition, some may experience internal sensations more vividly than others, or they may focus more attention on those symptoms. Patients with somatoform disorders are also very suggestible. In one study, somatoform patients were found more responsive to hypnotic suggestions than matched controls. Furthermore, the hypnotic susceptibility scores of conversion patients significantly correlated with the number of conversion symptoms reported by them.

Somatoform disorders have a higher prevalence in cultures that discourage open discussions on emotions or stigmatise psychological disorders. In Western culture subgroups such as the police or the military, discussing feelings and self-disclosing of psychological problems are frowned upon.

In such situations, somatic symptoms may begin to appear as the only acceptable outlet for feelings of emotional distress in such persons. The same may occur in people who are subjected to severe emotional constrictions, making them unable to acknowledge their emotions or verbally communicate them to others.