Spirit Catches You and You Fall Down (Fadiman)

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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