Spirit Catches You and You Fall Down (Fadiman)

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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