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In The Spirit Catches You and You Fall Down, Anne Fadiman argues that the cultural differences between western civilization and the Hmong hilltribe people led a young girl with epilepsy into a vegetative state. The author does a good job at supporting her argument with evidence which include several interviews of people involved in this tragedy. The author achieves the stated purpose of the book by giving a detailed storyline explaining the events leading up to the young Hmong girl’s, Lia Lee, vegetative state. The cultural differences between western medicine and the Hmong society created misunderstandings between the Lee’s, the Hmong family, and the staff at Merced Medical Center in Merced, California.
In the organization of this book, it is broken down into 19 chapters, with notes on the source, bibliography, acknowledgements, and an index at the end. The book begins by describing the Hmong hilltribe people from Laos, Southeast Asia. This community is small and migrated to the United States in 1980 when they were driven out of southeast asia by the Chinese. The author traveled to Merced, California when she was hearing about all these misunderstandings between the hospital staff and their Hmong patients due to extreme cultural differences. In Chapter 1, she goes into detail about the traditional customs of giving labor in the Hmong community and how Lia’s, the Lee’s first child born in the United States, labor was so much different than their first 12 babies. In the Hmong culture, women gave birth in their one room huts and pulled the baby themselves out of the womb. The mother, Foua, wouldn’t make a noise and the father, Nao, would cut the umbilical cord and tie it with a string and bury the placenta under their hut. The Hmong had several different kinds of remedies they would use for medicine. A shaman was a person who could interact with the unseen world and negotiate with spirits to heal the person’s soul. The Hmong also believe in the dab, a bad spirit, in which they would take superstitious precautions to make sure there soul wasn’t taken by the dab. The author states how the Hmongs belief that when someone is sick, they can be healed through the soul, was the hardest difference between the medical staff and the Hmong patients to overcome. When Lia had her first seizure, by the time she had gotten to the hospital it had stopped, because of the language barrier and the staffs lack of Hmong speaking staff, the Lee’s couldn’t explain to the medical staff what had happened. Lia was discharged a few hours later and the medical records stated that Lia was diagnosed with pneumonia. A few months later, It took Lia actually seizing when she arrived at the hospital to get the correct diagnosis. In one of the Fadiman’s (1997) interviews, a doctor at the hospital stated that he believed Lia’s outcome would've been totally different if the doctors could have gotten her on the correct medicine right off the bat (p. 101).
To the Hmong, people with epilepsy “experienced s “experienced powerful senses of grandeur and spiritual passion during their seizures and powerful creative urges in their wake” (Fadiman 1997 p.28). The author explains how they believe epileptics have a special connection with spirits which was a blessing. This belief and their language barrier made it extremely difficult for the Hmong to keep track of all the medication they were suppose to administer to Lia and what time of day to do it. The storyline takes a sad turn when the hospital called DCFS because they claimed that Lia’s parents weren’t doing their job as parent’s at taking care of their child. Lia was put into foster care for 6 months until the court finally came to the conclusion that Lia’s parents didn’t understand the medication regimen. In the end, it took one seizure lasting 2 hours that forced Lia into a vegetative state. It was only then, that the doctors let Lia’s parents take their daughter home and practice the medicine that they were familiar to.
In this book, the author did a great job at supporting her thesis of the cultural differences being the underlying cause of Lia Lee’s ultimate vegetative state. Her interviews with the medical staff and others involved in the tragedy really make the story come to life and the reality of western medicine practice. The author does an excellent job explaining the Hmong culture because it is so unique and different for majority of the readers. The author refers to specific vocabulary used in the Hmong community and makes sure she defines them in a clear, precise way. Anne Fadiman paints a picture of the Hmong lifestyle before and after they were forced to migrate to the United States. The great detail Fadiman uses illustrates the extreme differences of the two cultures wonderfully which helps support her thesis. There were few weaknesses this book. The book does a good job of defining the different Hmong culture, however, fails to define any medical terms used in the book. Most the time it wasn’t that important to know what the terms meant, but if you are not in the medical field, these aspect of the book were difficult to understand. The medical terms used were confusing but they weren’t important in the overall theme, as long as you understood that the treatments were far from anything the Hmong culture were use to.
Overall, The Spirit Catches You and You Fall Down is an eye-opening book about medical practice in the western civilizations. The cultural differences between the Hmong and western civilizations clash which drives a young Hmong child into a vegetative state for the rest of her life. This book reminds you that it is important for medical professionals to compromise with patients with difficult cultures yet still keep in mind that the duty of your job is to heal people. This book opens the mind to different medical practices and that maybe the way western medicine is practiced isn’t perfect and necessarily the only way healing can be done. I would recommend this book to anyone who's a medical professional or interested in the medical field.
Laura Esche
