The Hmong Sudden Death Syndrome

Vang Xiong is a former Hmong (Laotian) soldier who, with his wife and child, was resettled in Chicago in 1980. The change from his familiar rural surroundings and farm life to an unfamiliar urban area must have produced a severe “culture shock.” In addition, Vang vividly remembered seeing people killed during his escape from Laos, and he expressed feelings of guilt about having to leave his brothers and sisters behind in that country. He reported having problems almost immediatly.

[He] could not sleep the first night in the apartment, nor the second, nor the third. After three nights of sleeping very little, Vang came to see his resettlement worker, a young bilingual Hmong [pronounced “mong”] man named Moua Lee. Vang told Moua that the first night he woke suddenly, short of breath, from a dream in which a cat was sitting on his chest. The second night, the room suddenly grew darker, and a figure, like a large black dog, came to his bed and sat on his chest. He could not push the dog off, and he grew quickly and dangerously short of breath. The third night, a tall, white-skinned female spirit came into his bedroom from the kitchen and lay on top of him. Her weight made it increasingly difficult for him to breathe, and as he grew frantic and tried to call out he could manage but a whisper. He attempted to turn onto his side, but found he was pinned down. After fifteen minutes, the spirit left him, and he awoke, screaming. (Tobin, J. J., & Friedman, J. (1983) Spirits, shamans, and nightmare death: Survivor stress in a Hmong refugee. American Journal of Orthopsychiatry, 53, 439-448)

About 117 of the SE Asian refugees who settled in the United States have died from the “Hmong sudden death syndrome.” All reports were the same: a person in apparently good health went to sleep and died in his or her sleep. Often, the victim displayed labored breathing, screams, and frantic movements just before death. The Centers for Disease Control investigated these mysterious deaths, but no medical cause has yet been found (Centers for Disease Control, 1988). Some consider the deaths to represent an extreme and very specific example of the impact of psychological stress on physical health.

Vang was one of the lucky victims of the syndrome — he survived it. He went for treatment to a Hmong woman, Mrs. Thor, who is highly respected in Chicago’s Hmong community as a shaman. She interpreted his problem as being caused by unhappy spirits and performed the ceremonies that are required to release them. After that, Vang reported, he had no more problems with nightmares or with his breathing during sleep.

As of 1993, 150 cases of sudden death among Southeast Asian refugees have been reported. All have involved men (possibly one or two have involved women), and most occur within the first two years of living in the United States. The number of cases, however, is declining. Autopsies have found no identifiable cause for the deaths. Some cases of sudden unexplained deaths have also been reported in Asian countries. This remains the most puzzling phenomenon (Gib Parrish, Center for Desease Control, personal communication, 1993).1

Recruited in the 1960s by the CIA to fight Vietcong incursions into a landlocked country known to U.S. pilots as “the other theater,” the rebel army swelled to 40,000. Many fighters and their extended families — mostly ethnic Hmong — fled Laos after the Communist Pathet Lao seized control in 1975.i Some 100,000 Hmong later resettled in the U.S. — some in Washington state — and were given generous welfare support as a reward for their role in a shadowy war.2

i In 1975, when the contested lands of Southeast Asia fell to the communists, the Hmong lost everything. Thousands of Hmong officers, soldiers and their families were evacuated to Thailand, France, Canada and the U.S.
— Sally Macdonald, “Veterans to honor, help the Hmong farmers hurt by weather,” The Seattle Times, 8 Nov 1999.


1 David Sue, Derald Sue, and Stanley Sue, Understanding Abnormal Behavior, 4th ed. (Mass.: Houghton Mifflin Co., 1994), p. 227.

2 Simon Montlake (The Christian Science Monitor), “Once aided by U.S., rebels in Laos ‘trying to stay alive’,” The Seattle Times, 4 July 2003.