Monday, September 19, 2011

SUDDEN UNEXPECTED NOCTURNAL DEATH SYNDROME

A couple of years ago I was chatting in the corridor of a university medical center with a cardiologist I know. Quite a personable physician, he's an associate professor of medicine, at the top of his craft.
I asked him one of the naïve questions I habitually put to my colleagues. "Tell me," I said, "do you ever think of your patients as soft-hearted or heavy-hearted? Stone-hearted? Heartbroken? That kind of thing?"
"Sure, my patients go through the same kind of social trials and tribulations everyone does."
"What I mean is: do you ever think they're telling a single story, not two? That their cardiomyopathy might express that they've been too big-hearted, or that their heart aches because of a great loss?"
Suddenly he remembered an appointment and marched off, leaving me to guess he was avoiding this conversation. Understandable, since after all, if you're a Catholic priest you don't want to be seen discussing Mormonism in St. Peter's cathedral. 
The September issue of Atlantic magazine reviews a book by Shelley Adler, Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection (http://www.theatlantic.com/life/archive/2011/09/the-dark-side-of-the-placebo-effect-when-intense-belief-kills/245065/.) Part of the book describes the death, in their sleep, of 117 Hmong men who'd immigrated to the United States. They were posthumously diagnosed with "Sudden Unexpected Nocturnal Death Syndrome," or SUNDS. Adler concludes,
"It is my contention that in the context of severe and ongoing stress related to cultural disruption and national resettlement (exacerbated by intense feelings of powerlessness about existence in the United States), and from the perspective of a belief system in which evil spirits have the power to kill men who do not fulfill their religious obligations, the solitary Hmong man confronted by the numinous terror of the night-mare (and aware of its murderous intent) can die of SUNDS."
When you die of SUNDS, what exactly is the physiological culprit? No one's sure, but one hypothesis is a cardiac arrhythmia. Whatever the mechanism, though, the question remains: why that, and why in this person, at this time? I'd like to ask my cardiologist friend if these 117 men had troubled hearts before they died
SUNDS sounds like death by voodoo curse, doesn't it? Actually, it's known around the world. In Indonesia, it's called digeunton ("pressed on"). In China, it's bei gui ya ("held by a ghost"). The Hungarians know it as boszorkany-nyomas, "witches' pressure." If this phenomenon isn't exclusively native to the Hmong, it's worth studying not as a supernatural visitation, but as still further evidence that the mind affects the body.
Of course, we already know that. The love of our life enters the room, and our hearts flutter. A stranger is rude, and our blood pressure rises. Nine-year-olds have no trouble discovering this principle on their own, yet it seems totally alien to medical practice. We docs are trained to see human beings as biomechanical devices, organisms driven by genes, diet, hormones, and other physical forces, almost to the exclusion of influences from their inner world. It's as though we studied traffic accidents by taking cars apart, hardly glancing at the driver.   
Believing healthcare to be wholly a "scientific" endeavor, we suspend our common sense, deferring to those who regard only the measurable as worthy of analysis. I suspect we do that so readily because even though lifelong experience tells us that body and mind are inevitably connected, we have trouble entertaining an image of how that works.
Alright, try this. Look in a mirror. See your face carefully, imagining what this person is thinking. Now remember the last time you were angry. You'll see that in your face. In fact, recall anger and try not to display it, however subtly. 
We constantly speak what's called "body language." We can't stop. Try turning it off and a proficient observer will call you on it, saying you're trying not to express yourself, which, of course, is an expression. A simple body-mind model, then, is this: when you look at Willy's physical presence, you're seeing his mind in action. (It gets more complicated when Willy speaks, as the language of the mouth doesn't always coincide with that of the body, but that's for another day's blog.) 
Why not give this model a try for a couple of days? Look more carefully at others while mumbling to yourself the mantra, "Actions speak louder than words." Then report in, eh?

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