Spirit Catches You and You Fall Down (Fadiman)

The Spirit Catches You and You Fall Down: A Hmong Child, Her American doctors, and the Collision of Two Cultures
Anne Fadiman, 1997
Farrar, Straus and Giroux
368 pp.
ISBN-13: 9780374533403

Summary 
1997 Winner, National Book Critics Circle Award - Nonfiction

Brilliantly reported and beautifully crafted, The Spirit Catches You and You Fall Down explores the clash between the Merced Community Medical Center in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia's parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy. (From the publisher.)

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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. (Also from the publisher.)

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Author Bio 
• Birth—August 7, 1953
• Where—New York, New York, USA
• Education—Harvard University
• Awards—National Book Critics Circle Award, 1997; National
   Magazine Award - Reporting
• Currently—New York City

Anne Fadiman is the recipient of a National Magazine Award for Reporting, she has written for Civilization, Harper's, Life, and the New York Times, among other publications. She lives in New York City. (From the publishers.)

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Anne Fadiman is an American author, editor and teacher. She is the daughter of the renowned literary, radio and television personality Clifton Fadiman and World War II correspondent and author Annalee Jacoby Fadiman. She attended Harvard University, graduating in 1975 from Radcliffe College at Harvard.

Researched in California, her 1997 book, The Spirit Catches You, examines Hmong family with a child with epilepsy, and their cultural, linguistic and medical struggles in America.

She's written two books of essays, Ex Libris: Confessions of a Common Reader (1998) and At Large and At Small: Familiar Essays (2007), and edited Rereadings: Seventeen Writers Revisit Books They Love (2005).

Fadiman was a founding editor of the Library of Congress magazine Civilization, and was the editor of the Phi Beta Kappa quarterly The American Scholar. She was forced out of her position at The American Scholar in 2004 in a dispute over budgetary and other issues.

As of January 2005, in a program established by Yale alumnus Paul E. Francis, Anne Fadiman became Yale University's first Francis Writer in Residence, a three-year position which allows her to teach a non-fiction writing seminar, and advise, mentor and interact with students and editors of undergraduate publications. Fadiman is married to the American author George Howe Colt. (From Wikipedia.)

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Book Reviews 
Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different.
Richard Bernstein - New York Times

This fine book recounts a poignant tragedy.... It has no heroes or villains, but it has an abunance of innocent suffering, and it most certainly does have a mora.... [A] sad, excellent book.
Melvin Konner - New York Times Book Review

An intriguing, spirit-lifting, extraordinary exploration of two cultures in uneasy coexistence.... A wonderful aspect of Fadiman's book is her evenhanded, detailed presentation of these disparate cultures and divergent views—not with cool, dispassionate fairness but rather with a warm, involved interest.... Fadiman's book is superb, informal cultural anthropology—eye-opening, readable, utterly engaging.
Carole Horn - Washington Post Book World

I cannot think of a book by a non-physician that is more understanding of the difficulties of caring for people...or of the conditions under which today's medicine is practiced.
Sherwin B. Nuland - New Republic

When two divergent cultures collide, unbridgable gaps of language, religion, social customs may remain between them. This poignant account by Fadiman, editor of The American Scholar, of the clash between a Hmong family and the American medical community reveals that among the gaps yawns the attitude toward medicine and healing. The story focuses on Lia Lee, whose family immigrated to Merced, Calif., from Laos in 1980. At three months of age, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, 'the spirit catches you and you fall down.' Fadiman traces the treatments for Lia's illness, observing the sharp differences between Eastern and Western healing methods. Whereas the doctors prescribed Depakene and Valium to control her seizures, Lia's family believed that her soul was lost but could be found by sacrificing animals and hiring shamans to intervene. While some of Lia's doctors attempted to understand the Hmong beliefs, many interpreted the cultural difference as ignorance on the part of Lia's parents. Fadiman shows how the American ideal of assimilation was challenged by a headstrong Hmong ethnicity. She discloses the unilateralness of Western medicine, and divulges its potential failings. In Lia's case, the two cultures never melded and, after a massive seizure, she was declared brain dead. This book is a moving cautionary tale about the importance of practicing "cross-cultural medicine,' and of acknowledging, without condemning, differences in medical attitudes of various cultures.
Publishers Weekly

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. —Rebecca Cress-Ingebo, Fordham Health Sciences Library, Wright State University, Dayton, OH
Library Journal

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
School Library Journal

A vivid, deeply felt, and meticulously researched account of the disastrous encounter between two disparate cultures: Western medicine and Eastern spirituality, in this case, of Hmong immigrants from Laos. Fadiman, a columnist for Civilization and the new editor of The American Scholar, met the Lees, a Hmong refugee family in Merced, Calif., in 1988, when their daughter Lia was already seven years old and, in the eyes of her American doctors, brain dead. In the Lees' view, Lia's soul had fled her body and become lost. At age three months Lia had had her first epileptic seizure—as the Lees put it, "the spirit catches you and you fall down." Lia's treatment was complex—her anti-convulsant prescriptions changed 23 times in four years—and the Lees were sure the medicines were bad for their daughter. Believing that the family's failure to comply with his instructions constituted child abuse, Lia's doctor had her placed in foster care. A few months after returning home, Lia was hospitalized with a massive seizure that effectively destroyed her brain. With death believed to be imminent, the Lees were permitted to take her home. Two years later, Fadiman found Lia being lovingly cared for by her parents. Still hoping to reunite her soul with her body, they arranged for a Hmong shaman to perform a healing ceremony featuring the sacrifice of a live pig in their apartment. Into this heart-wrenching story, Fadiman weaves an account of Hmong history from ancient times to the present, including their work for the CIA in Laos and their resettlement in the U.S., their culture, spiritual beliefs, ethics, and etiquette. While Fadiman is keenly aware of the frustrations of doctors striving to provide medical care to those with such a radically different worldview, she urges that physicians at least acknowledge their patients' realities. A brilliant study in cross-cultural medicine.
Kirkus Reviews

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Discussion Questions 
1. What do you think of traditional Hmong birth practices (pp. 3-5)? Compare them to the techniques used when Lia was born (p. 7). How do Hmong and American birth practices differ?

2. Over many centuries the Hmong fought against a number of different peoples who claimed sovereignty over their lands; they were also forced to emigrate from China. How do you think these up-heavals have affected their culture? What role has history played in the formation of Hmong culture?

3. Dr. Dan Murphy said, "The language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier. There is a tremendous difference between dealing with the Hmong and dealing with anyone else. An infinite difference" (p. 91). What does he mean by this?

4. The author says, "I was struck...by the staggering toll of stress that the Hmong exacted from the people who took care of them, particularly the ones who were young, idealistic, and meticulous" (p. 75). Why do you think the doctors felt such great stress?

5. Dr. 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. I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior" (p. 79). Do you think the Hmong understood this message? Why or why not? What do you think of Neil and Peggy?

6. Dr. Roger Fife is liked by the Hmong because, in their words, he "doesn't cut" (p. 76). He is not highly regarded by some of the other doctors, however. One resident went so far as to say, "He's a little thick." What do you think of Dr. Fife? What are his strengths and weaknesses? The author also speaks of other doctors who were able to communicate with the Hmong. How were they able to do so? What might be learned from this?

7. How did you feel about the Lees' refusal to give Lia her medicine? Can you understand their motivation? Do you sympathize with it?

8. How did you feel when Child Protective Services took Lia away from her parents? Do you believe it was the right decision? Was any other solution possible in the situation?

9. Were you surprised at the quality of care and the love and affection given to Lia by her foster parents? How did Lia's foster parents feel about Lia's biological parents? Was foster care ultimately to Lia's benefit or detriment?

10. How did the EMT's and the doctors respond to what Neil referred to as Lia's "big one"? Do you think they performed as well as they could have under the circumstances?

11. How does the greatest of all Hmong folktales, the story of how Shee Yee fought with nine evil dab brothers (p. 170), reflect the life and culture of the Hmong?

12. Discuss the Lees' life in Laos. How was it different from their life in the United States? Foua says, "When we were running from Laos at least we hoped that our lives would be better. It was not as sad as after Lia went to Fresno and got sick" (p. 171). What were the Lees running from? What were they hoping to find in the United States?

13. When polled, Hmong refugees in America stated that "difficulty with American agencies" was a more serious problem than either "war memories" or "separation from family." Why do you think they felt this way? Could this have been prevented? If so, how? What does the author believe?

14. The Hmong are often referred to as a "Stone Age" people or "low-caste hill tribe." Why is this? Do you agree with this assessment of Hmong culture? Does the author?

15. What was the "role loss" many adult Hmong faced when they came to the United States? What is the underlying root cause? How does this loss affect their adjustment to America?

16. What are the most important aspects of Hmong culture? What do the Hmong consider their most important duties and obligations? How did they affect the Hmong's transition to the United States?

17. What does Dan Murphy mean by, "When you fail one Hmong patient, you fail the whole community" (p. 253)?

18. The author gives you some insight into the way she organized her notes (p. 60). What does it say about the process of writing this book? She chooses to alternate between chapters of Lia's story and its larger background-the history of the Lee family and of the Hmong. What effect does this create in the book?

19. The concept of "fish soup" is central to the author's understanding of the Hmong. What does it mean, and how is it reflected in the structure of the book?

20. It is clear that many of Lia's doctors, most notably Neil Ernst and Peggy Philp, were heroic in their efforts to help Lia, and that her parents cared for her deeply, yet this arguably preventable tragedy still occurred. Can you think of anything that might have prevented it?

21. What did you learn from this book? Would you assign blame for Lia's tragedy? If so, to whom? What do you think Anne Fadiman feels about this question?
(Questions from the publisher.)

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