Ang Salumpuwit ni Aputiktik

Religious Fanatics

Fried in our own lard

Starry, starry night

How Safe is the Pinoy?

References:

(Note: I did not do a literature search for more recent years. These references date back to an article I did in 1996. You can try an Internet search on the keywords Sudden Unexplained Nocturnal Deaths.)

Adler S. Refugee stress and folk belief: Hmong sudden deaths. Soc Sci Med 1995;40(12):1623-1629.)

Aponte, Gonzalo E. The enigma of 'bangungot.' Archives of Internal Medicine 1960;52:1258-1263.

Centers for Disease Control (U.S. Department of Health and Human Services). Sudden, unexpected, nocturnal deaths among Southeast Asian refugees. Morbidity and Mortality Weekly Report 1981;30(47):581-584,589.

Koh KT et al. Sudden nocturnal deaths among Thai construction workers in Singapore. Lancet 1990;335:1154.

Lonsdale D. Thiamine deficiency and sudden deaths. Lancet 1990;336:376.

Munger RG and Booton EA. Thiamine and sudden death in sleep of South-East Asian refugees. Lancet 1990;335:1154.

Nimmannit S et al. Potassium and sudden unexplained nocturnal death. Lancet 1990;336:116-117.

Nolasco, J. B. An inquiry into 'bangungot'. Archives of Internal Medicine 1957;99:905-912.

Phua KH et al. Thiamine deficiency and sudden deaths: lessons from the past. Lancet 1990;335:1471-1472.

Pollanen MS, et al. Sudden unexplained death in Asian immigrants: recognition of a syndrome in metropolitan Toronto. Canadian Medical Association Journal 1996; 155:537-540.

Santa Cruz, Florencio Z. The pathology of bangungot. Journal of the Philippine Islands Medical Association 1951;27(7):476-481.

Yap EH et al. Pseudomonas pseudomallei and sudden unexplained death in Thai construction workers. Lancet 1990;336:376-377.

Bangungot

M. L. Tan

The stories are familiar -- a relative or a friend, usually a male, dies suddenly in his sleep, without any history of illness. Relatives or companions in the house will recall hearing the victim moan that fateful night, and friends will nod their heads as they agree on a postmortem diagnosis: bangungot.

This nightmare syndrome is also found in other cultures, dubbed lai tai by the Thais and tsob tsuang by the Hmong of Vietnam. The Tagalog term bangungot is derived from bangon (to rise) and ungol (to moan). In daily colloquial use, bangungot often refers to nightmares in general, and do not necessarily end fatally; nevertheless, there is a real fear that the nightmare might become more dangerous and deadly.

These nightmare deaths have caught the attention of medical researchers. There was a report on bangungot in a local medical journal as early as 1917. In the 1950s, sudden deaths among Filipino sailors in the US Navy led to more reports in American medical journals. In the late 1970s, the Americans coined the term Sudden Unexplained Noctural Death (SUND) to describe mysterious deaths among Southeast Asian refugees, mainly from the Hmong of Vietnam. In 1990, a series of articles appeared in the British journal, The Lancet, reporting on such deaths among Thai construction workers in Singapore. Through the years, there have been other sporadic reports in the journals of deaths among Cambodian and Lao men in north America as well as refugee camps in Thailand.

Filipinos attribute bangungot to going to bed right after a very full meal. The medical researchers have their own crop of theories. The earliest investigations, based on autopsies of Filipino victims, suggested pancreatitis as the cause of death, with speculation that our high salt diet of bagoong and patis. In the 1980s, doctors at the University of the East proposed the victims had coongenital problems in their heart's anatomical structure. The deaths among Thai workers in Singapore led researchers to zero in once again on dietary factors, with suggestions that the problem was associated with nutritional deficiencies - some suggested thiamine, others potassium.

These diverse explanations underscore the need to expand our perspectives on illnesses. Problems like bangungot - as well as many other health problems -- cannot be explained as having just one cause.

An area that has been neglected in this nightmare death research is the role of mental health. Notice how, in all the countries with this syndrome, the ones who are most often affected are males going through the stress of migration or being away from home -- Filipino sailors out at sea, Thai construction workers in Singapore, and southeast Asian refugees in north America. Since males in these cultures often have to put up a façade of stoic strength, even during very difficult times, they may not be able to express their anxieties openly. Suppressing these emotions could make them more susceptible to this sudden death syndrome.

Nutritional problems, congenital defects in the heart, and stress may all be co-factors that contribute to the sudden deaths. There's also the cultural factor: we are raised to dread bangungot so a person having a nightmare might panic, which only worsens the situation as shock sets in, shutting down the body's systems.

Bangungot is intriguing because of the insights it gives us into how humans interpret our physical experiences. Nightmares are universal and because they are so terrifying, many cultures have associated these with malignant spirits and danger. At the turn of the 20th century, an American anthropologist wrote about the Bontoc's belief in the li-mum, described as a spiritual form of the human body which causes "fiendish nightmares by sitting on the sleeping individual's breast and stomach." Similarly, the English word nightmare originally referred to a "mare", a female spirit that was believed to suffocate sleeping victims.

There's even a theory now that reports of alien abductions in the United States may actually be contemporary interpretations of our nightmares. The "victims" of these abductions also complain of a heavy feeling in their chests, except that this is attributed to extra-terrestial creatures poking around in their bodies or, worse, being carnally ravished by these lustful aliens.

The description of something or someone sitting on the chest - hearts beating frantically from eating too much or being eaten by aliens - suggests that persons with frequent bangungot experiences might want to have themselves checked for heart problems. Health professionals, in turn, might do well to advise these patients on stress-coping mechanisms, including our own traditional remedy, which I'm going to describe next.

Our fear of bangungot boils down to our dreading our loss of control, of being trapped within the nightmare. Our bangungot beliefs include a remedy, which is for the victim to try to move a finger, a toe or any part of the body, or to have someone else wake you up. The point is to regain control and to slip out of the nightmare.

Bangungot is part of an indigenous psychology, based on a knowledge that loss of control over our bodies and our lives can be hazardous. Bangungot beliefs also reflect social norms - one shouldn't be a glutton, and shouldn't dash off to bed right after a full meal. Politicians should take heed - when Filipinos compare the present dispensation to a never-ending bangungot, as they are beginning to do so now, it suggests malaise and discontent on a grand scale. I would extend this metaphorical use of this deadly ightmare syndrome: when our leaders go to bed on too full a meal, the nation suffers, grievously, from collective bangungot.