The Spirit Catches You and You Fall Down, by Anne Fadiman

In the 1970s, after the end of the Laotian Civil War, tens of thousands of Hmong people fled the country. Many of them came to the United States because so many of the men had fought against communists on behalf of the CIA and U.S. Government. But, unlike so many migrant groups, the Hmong are so fiercely proud of their culture, religion, and identity and so resistant to assimilation that they have been in conflict with American culture and bureaucracy right from the beginning. In Anne Fadiman’s The Spirit Catches You and You Fall Down, we see a tragic conflict of cultures when a young Hmong girl with epilepsy is brought into the Merced Community Medical Center.

Lia Lee was born in Merced, California, in 1982 to parents who had fled from Laos only a few years prior. Three months after her birth, her parents, Foua Yang and Nao Kao Lee, rushed her to Merced Community Medical Center because she had had a seizure. At first, the doctors didn’t see Lia seizing and could only send her home. When they did see her experiencing a seizure, it set off a scramble involving several doctors, nurses, and social workers to get Lia’s seizures under control. For months, the doctors struggled to find the right combination of drugs that would control Lia’s epilepsy, while interpreters and social workers attempted to explain that drug regime to Foua and Nao Kao.

Many of the documents in Lia’s medical records, later examined by Fadiman, state that the parents understand and agree to the treatment. The problem is that neither of Lia’s parents spoke English. They were not literate in Hmong or Lao, either, so written instructions were out. Not only did they not speak English, but they did not understand what was happening or the doctors were trying to do. All the doctors saw was a couple who refused to give their daughter the medicine that would control her seizures. But from the perspective of the Lees, the doctors were failing, over and over, to help their daughter. They saw their daughter in pain from all the IVs used to give Lia sedatives to stop the seizures. They also saw doctors ignore and scorn their cultural and religious beliefs and do things that were incomprehensible to the Lees. The entire situation was a massive failure of communication.

Hmong girl in China, by Michael Mooney (Image via Wikicommons)

Lia’s story and the recent history of the Hmong are the foundation for Fadiman’s larger exploration of the need for cross-cultural education for not just doctors but everyone who works in public services. Fadiman dives deeply into the culture, language, and religion of the Hmong to explain the stark differences between Hmong people and Americans. Due to their deliberate isolation from the rest of the world right up to the 1970s, Hmong people of Foua and Nao Kao’s generation are completely unfamiliar with Western medicine. Fadiman notes at one point that the Hmong language lacks words for some internal organs because Hmong people do not practice autopsy. (There is a taboo about blood and amputation that frequently caused conflicts over surgeries.) Hmong people also suffered from soul illness that kind of but do not correlate to post-traumatic stress disorder and depression that do not translate into English; worse, some doctors didn’t take these illnesses seriously. Even when the doctors and nurses had someone who spoke Hmong to interpret, there were still problems fully translating. Only later, in the 1990s and 2000s, when staff at Merced Community and other hospitals began to collaborate with Hmong shamans and try to incorporate Hmong healing with Western medicine, did the cases like Lia’s become rare.

The Spirit Catches You and You Fall Down is a fascinating and heart-breaking book about an impossible medical/ethical dilemma. Fadiman wrote a deeply empathetic and erudite book about Lia and her family, the Hmong people, and their ongoing trials in America, a country where they had hoped to find a more peaceful existence. I truly appreciated her fairness in this book. She includes interviews with both Lia’s doctors and her family. No one is really to blame in Fadiman’s account, though several doctors admit that they could have done more or that they made mistakes in Lia’s case. Above all, this is a very human book about the mistakes we make when we encounter people we just don’t understand.

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