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The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman
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Winner of the National Book Critics Circle Award for Nonfiction
When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.
Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.
- Sales Rank: #82736 in Books
- Brand: Farrar, Straus and Giroux
- Published on: 1997-09-30
- Ingredients: Example Ingredients
- Original language: English
- Number of items: 1
- Dimensions: 9.58" h x 1.19" w x 6.40" l, 1.40 pounds
- Binding: Hardcover
- 352 pages
- Great product!
Amazon.com Review
Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty--and their nobility."
From School Library Journal
YA?A compelling anthropological study. The Hmong people in America are mainly refugee families who supported the CIA militaristic efforts in Laos. They are a clannish group with a firmly established culture that combines issues of health care with a deep spirituality that may be deemed primitive by Western standards. In Merced, CA, which has a large Hmong community, Lia Lee was born, the 13th child in a family coping with their plunge into a modern and mechanized way of life. The child suffered an initial seizure at the age of three months. Her family attributed it to the slamming of the front door by an older sister. They felt the fright had caused the baby's soul to flee her body and become lost to a malignant spirit. The report of the family's attempts to cure Lia through shamanistic intervention and the home sacrifices of pigs and chickens is balanced by the intervention of the medical community that insisted upon the removal of the child from deeply loving parents with disastrous results. This compassionate and understanding account fairly represents the positions of all the parties involved. The suspense of the child's precarious health, the understanding characterization of the parents and doctors, and especially the insights into Hmong culture make this a very worthwhile read.?Frances Reiher, Fairfax County Public Library, VA
Copyright 1998 Reed Business Information, Inc.
From Library Journal
Award-winning reporter Fadiman has turned what began as a magazine assignment into a riveting, cross-cultural medicine classic in this anthropological exploration of the Hmong population in Merced County, California. Following the case of Lia (a Hmong child with a progressive and unpredictable form of epilepsy), Fadiman maps out the controversies raised by the collision between Western medicine and holistic healing traditions of Hmong immigrants. Unable to enter the Laotian forest to find herbs for Lia that will "fix her spirit," her family becomes resigned to the Merced County emergency system, which has little understanding of Hmong animist traditions. Fadiman reveals the rigidity and weaknesses of these two ethnographically separated cultures. In a shrinking world, this painstakingly researched account of cultural dislocation has a haunting lesson for every healthcare provider. Highly recommended for all collections.?Rebecca Cress-Ingebo, Fordham Health Sciences Lib., Wright State Univ., Dayton, Ohio
Copyright 1997 Reed Business Information, Inc.
Most helpful customer reviews
4 of 4 people found the following review helpful.
“I have one rule. Before I do anything, I ask ‘Is it Okay?’”
By Lord Galderon
I thoroughly enjoyed The Spirit Catches You and You Fall Down. I can understand why over the course of the past decade, it has become required reading for many students entering health care professions. It painted such a detailed picture of not only a specific incidence of cultural collisions with the Lee family and doctors of Merced, CA, but also how these collisions occur in other cultures and in other instances across America and the world. I felt that it was extremely thorough and fair to both the Hmong experience and the Lee family, and also that of the doctors at MCMC. I could feel and relate to the horrors and frustrations on both sides, and fully understood how and why it was so difficult to reach common ground. I had a deep sense of empathy for Lia, who was the innocent victim of an almost unavoidable cultural gap.
The culture expressed by the Hmong people is vastly different from that of Western culture, and even most Eastern culture and neighboring Asian countries. For example, there is a passage in the book that explains common gestures and social interactions that are considered inappropriate to the Hmong: “Doctors could also appear disrespectful if they tried to maintain friendly eye contact (which was considered invasive), touched the head of an adult without permission (grossly insulting), or beckoned with a crooked finger (appropriate only for animals). It was important to never to compliment a baby’s beauty out loud, lest a dab (an evil spirit) overhear and be unable to resist snatching its soul
The Hmong community in Merced, California are in desperate need of translators. Not only language translators, but more importantly, cultural translators. They need cultural liaisons to not only guide them through western culture, but to educate westerners about their culture. One thing I thought was very poignant, was a quote by a psychologist at Merced Community Outreach Services, by the name of Sukey Walker. She found a way to interact and communicate with the Hmong that was better than any of her American counterparts. She detailed one of her keys to success : “I have one rule. Before I do anything, I ask ‘Is it Okay?’”
This is a very real book. It is very heartbreaking, and very true to life. There was no happy ending or easy solution to the problems in this book. However, there is a certain amount of optimism expressed here, and it made me very hopeful and eager to see these cultural barriers deconstructed.
6 of 6 people found the following review helpful.
Cultural / Medical Clashes & A Charming Toddler
By TulipGirl
Anne Fadiman tells the story of little Lia Lee, a Hmong-American child with epilepsy, and weaves together the woof of parental love and biomedical treatment with the warp of Hmong and American cultures. This book brings into focus how extensively cross-cultural transitions impact both the approaching and approached peoples. In an interview in 2001, Fadiman explains what drew her so deeply into this book, "Yes, it is about an epileptic Hmong toddler, but it is also about many other things. . . I started pulling on a slender thread, the thread that was Lia Lee, the small sick child . . . I pulled on the thread and the thread became a string and the string became a rope, and then I tugged really hard on the rope and I discovered that it was attached to the entire universe."
Fadiman alternates chapters about Lia with chapters on the history and culture of the Hmong people. Interwoven in Lia's story is the story of her people. The parallel can be drawn that the spirit catches the Hmong people with wars and threats of assimilation, and in response the Hmong eschew resistance and migrate. Most of Merced's Hmong population came to the U.S.
Lia's parents wanted "a little medicine and a little txib" (p. 110.) While medical care at MCMC was provided at no charge, Lia's family spent large sums on buying amulets, having a tvix neeb perform ceremonies, and sacrificing chickens, pigs, and even a cow. Foua would grow herbs and make special concoctions both for feeding to Lia as well as bathing her. The author was privileged to be present when the family sacrificed a pig in their living room in order to seek her wandering soul and bring it back to Lia.
From the doctors' perspective Neil Ernst said, "I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids' lives" (p. 59.)
The Spirit Catches You and You Fall Down was both thought-provoking and emotionally rewarding. It is recommend for those who enjoy a well-told story, as well as those working in public health fields, interested in cross-cultural transitions, or who have special interest in the Hmong people.
Anne Fadiman discussed Lia Lee with medical anthropologist Arthur Kleinman. His observations brings out the crucial point (p. 260), "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?"
Where is Lia Lee now? In a Newsweek article in 2005, then 22 year old Lia was still in a persistent vegetative state, still cared for at home by her careful and loving mother.
0 of 0 people found the following review helpful.
Amazing story everyone should read!
By J. Lincoln
I bought this book for my Medical Anthropology course. In the end, it ended up being one of the best books I have ever read. It truly does tell an amazing story how our medical system and the cultural differences between peoples can cause more harm. Yet, it is very good at displaying the medical system not as evil but as products of society and culture. I cried through this book, also learned about a war I never even knew about. I would recommend this to everyone. Especially if you have an interest in the medical field or culture.
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