Customer Reviews for

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

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Most Helpful Favorable Review

11 out of 11 people found this review helpful.

A Must-Read for anybody in healthcare

As a physician myself, this book really hit close to home. It really was an eye-opener for everybody in the health care system as well as for anybody in the Western world to strive not to view the world in an ethnocentric manner. Most of the time, physicians have a 'tun...
As a physician myself, this book really hit close to home. It really was an eye-opener for everybody in the health care system as well as for anybody in the Western world to strive not to view the world in an ethnocentric manner. Most of the time, physicians have a 'tunnel vision' when interacting patients. Though oftentimes done without malice, it nevertheless disregards the patient as an individual with his/her own values and beliefs.This redefines medicine and focuses on it being an art rather than a science of treating patients as whole individual:body, mind and soul. Anne Fadiman succeeded in presenting the material not in an antagonistic way, by focusing on Lia and her family, and by providing a better understanding of the Hmong culture. I keep a copy in my office with the cover showing Lia's picture within easy view to serve as a reminder to me in my everyday interaction with patients.

posted by Anonymous on April 29, 2007

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Most Helpful Critical Review

5 out of 10 people found this review helpful.

Adequate writing, biased observations

While Fadiman¿s writing style is adequate and the book is easy to read, it only merits two circles. Fadiman¿s anti-American bias is evident throughout and her half-hearted attempts at objectivity are flaccid at best. Fadiman covers in detail what she feels is wrong with...
While Fadiman¿s writing style is adequate and the book is easy to read, it only merits two circles. Fadiman¿s anti-American bias is evident throughout and her half-hearted attempts at objectivity are flaccid at best. Fadiman covers in detail what she feels is wrong with the American doctors and their treatment of immigrants but the shortcomings of the Lees are mitigated. Lia¿s plight is sad, but blame can¿t be placed entirely on the American doctors and must be shared by the parents¿ inaction as well. Several of the doctors made valiant efforts to learn the idiosyncrasies of the Hmong culture in addition to their regular duties without compensation. Lia¿s parents¿ response lacks an equal spirit of cooperation by their steadfast refusal to learn more of the American culture and specifically American medicine. Regardless of how superior an immigrant feels his/her culture, or country of origin to be, it is incumbent upon the immigrant to learn the customs and language of the host culture. This is especially important where the health of a child is concerned and is illustrated by this book. Many counties in California offer free English classes for immigrants. Why didn¿t Lia¿s parents utilize this service? I would recommend this book as a cautionary tale to immigrants who fail to see the need of learning the language of their adopted country.

posted by Anonymous on May 11, 2007

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  • Anonymous

    Posted April 29, 2007

    A Must-Read for anybody in healthcare

    As a physician myself, this book really hit close to home. It really was an eye-opener for everybody in the health care system as well as for anybody in the Western world to strive not to view the world in an ethnocentric manner. Most of the time, physicians have a 'tunnel vision' when interacting patients. Though oftentimes done without malice, it nevertheless disregards the patient as an individual with his/her own values and beliefs.This redefines medicine and focuses on it being an art rather than a science of treating patients as whole individual:body, mind and soul. Anne Fadiman succeeded in presenting the material not in an antagonistic way, by focusing on Lia and her family, and by providing a better understanding of the Hmong culture. I keep a copy in my office with the cover showing Lia's picture within easy view to serve as a reminder to me in my everyday interaction with patients.

    11 out of 11 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted May 11, 2007

    Adequate writing, biased observations

    While Fadiman¿s writing style is adequate and the book is easy to read, it only merits two circles. Fadiman¿s anti-American bias is evident throughout and her half-hearted attempts at objectivity are flaccid at best. Fadiman covers in detail what she feels is wrong with the American doctors and their treatment of immigrants but the shortcomings of the Lees are mitigated. Lia¿s plight is sad, but blame can¿t be placed entirely on the American doctors and must be shared by the parents¿ inaction as well. Several of the doctors made valiant efforts to learn the idiosyncrasies of the Hmong culture in addition to their regular duties without compensation. Lia¿s parents¿ response lacks an equal spirit of cooperation by their steadfast refusal to learn more of the American culture and specifically American medicine. Regardless of how superior an immigrant feels his/her culture, or country of origin to be, it is incumbent upon the immigrant to learn the customs and language of the host culture. This is especially important where the health of a child is concerned and is illustrated by this book. Many counties in California offer free English classes for immigrants. Why didn¿t Lia¿s parents utilize this service? I would recommend this book as a cautionary tale to immigrants who fail to see the need of learning the language of their adopted country.

    5 out of 10 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Posted September 1, 2010

    I Also Recommend:

    THE SPIRIT CATCHES YOU AND YOU FALL DOWN, by Anne Fadiman,

    This is a compelling story of a family of Hmong immigrants and their struggles with the American medical community following the onset of their daughter's epilepsy. This book made me care about a whole host of things and people I had never heard of, the Hmong. This powerful tale, (true), is about the clash of two cultures and is written beautifully with great feeling. The reader sympathizes with both the terrible trouble that the Hmong people have had in recent years and with the plight of the American doctors of trying to treat people whose cultural life is so different from their own. Reads like fiction.Really good!!

    4 out of 4 people found this review helpful.

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  • Posted April 2, 2010

    more from this reviewer

    Justifiably won the National Book Critics Circle Award

    A moving and informative story on two counts.

    First, it is the story of Lia Lee, a little Hmong girl born in Merced CA, who suffered from a severe form of epilepsy, and the tragedy that occurred because of the vast cultural differences between her family and the doctors at Merced Community Medical Center who wanted nothing more than to help her.

    Second, and just as important, it is also the story of the Hmong, many of whom emigrated to the US from Laos as a result of the Vietnam War, and of the culture shock a great number of them went through when they came here.

    Because of this culture shock, Lia's epilepsy eventually caused her to go into an irreversible coma, and at the time Fadiman wrote this book she was still alive although in a completely vegetative state. The tragedy is that nobody in particular is really to blame for Lia's situation - the differences between her community (the Hmong) and the community that wanted to help her (the MCMC doctors) were just so vast as to make it next to impossible for a resolution to her illness to be found.

    Fadiman patiently makes friends not only with Lia's family, but with the Merced Hmong in general as well as the doctors and staff at MCMC who tried to help her. And she does not show any signs of anger or impatience in this effort, which shows in her narration of Lia's story - indeed, she shows nothing but respect for them. She is just as respectful with her history of the Hmong. There are no boring statistics or dry history to be found in this book - Fadiman throws in several pieces of Hmong folklore and legends to make their story more interesting.

    Reading this book I really wished for a miracle towards the end - that Lia would somehow come out of her coma and once again become a happy and healthy little girl. But unfortunately life does not always give us everything we want.

    4 out of 4 people found this review helpful.

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  • Posted November 11, 2009

    more from this reviewer

    The Spirit Catches You and You Fall Down

    The Spirit Catches You and You Fall Down by Anne Fadiman, describes the tumultuous life of the Lee family, a Hmong immigrant family with an epileptic special needs child. Many misunderstandings and cultural clashes occur because the Hmong people refuse assimilation into the American lifestyle. The Hmong will not accept American norms and they stubbornly cling to their traditions and culture against great odds and tumult. Life for the average new Hmong immigrant family is very complicated and unnerving, but the life of the Lee family is even more turbulent and disrupted because their epileptic thirteenth child, Lia, requires frequent medical attention or hospitalization.
    The Hmong society has their own methods of treatment for the sick and they fail to comply with the regulations and laws of the American Medical system. The father, Nao Kao Lee, and mother, Foua Yang, do not understand the reasoning behind the American medical procedures. Problems communicating with the medical practitioners and doctors who serve the Lee family are further compounded because neither of the parents can read nor speak English. The parents can write their names in English and will often sign consent forms that they do not understand in attempts to shorten the hospitalization. The family often does not comply with hospital regulations or with norms that relate to the medical profession because what they perceive as healing practices are not followed and instead foreign methods that are perceived to be harmful or not nurturing are introduced. Problems escalate when the Lees fail to properly administer prescribed medications to Lia. A cycle of unfortunate hospitalizations occurs, always ending with doctors at wits end to deal with the Lee family. Eventually, Lia is sent to live with the Kordas, a foster care family. In the end of the story Lia is again hospitalized for a seizure that places her into a comatose state. The Lee family must fight a long battle for the right to take Lia home again and finally they are granted the permission to take her home to provide love and nurturing until Lia's pending death. Their goal is always to reunite the family by taking Lia home and caring for her in the method they believe is best for their child.
    The Lee family is fortunate because a support group of doctors and health care workers have taken an interest in Lia and they want to find the best solution for Lia and the family. Jeannie Hilt is the primary social worker that works with the Lee family case. Jeannie Hilt is accepted and trusted by the Lee family to the extent that she is welcomed into their home. Jeannie Hilt's efforts help the family regain Lia after foster care.
    Other characters of the story are medical professionals who come to the aid of the Lee family. Neil Ernst is a doctor that dedicates much of his time and profession to helping the Lee family. He rushes to Merced Community Medical Center (MCMC) whenever he can to alleviate Lia's pain and to help Lia with her seizure. Doctor Ernst works very closely with his wife, Peggy Philp, to care for Lia almost as their exclusive patient. The teams of Neil Ernst and Peggy Philp have almost crossed professional boundaries because of their extent of devotion to Lia and the Lee family.

    4 out of 4 people found this review helpful.

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  • Anonymous

    Posted May 6, 2001

    A must for all interventionists

    The Spirit Catches You and You Fall Down by Anne Fadiman is the compelling story of Lia Lee, a young Hmong child with a progressive form of epilepsy, and the way in which her family's culture collided with the culture of her American doctors. Fadiman tells the Lee's story within the context of Lia's family history and the painful, complicated history of the Hmong people. The story she tells is a tragic one in which a lack of communication coupled with two radically different belief systems ultimately leads to a devastating cultural impasse. Fadiman tells Lia's story interspersed with descriptions of the struggles of the Hmong people during the Vietnam war, as well as how they were viewed once they came to America. For example, the Hmong viewed welfare checks as the promised repayment for their services in the war. Americans viewed the Hmong as draining limited services, jamming the schools, and taking money away from the states. Fadiman identifies the cultural barrier between the scientific based practices of the American doctors and the animistic, spiritual practices of the Hmong culture. This cultural barrier poses an even larger threat than the language barrier. She explains this effectively, while providing insight into methods that can be used to bridge the gap between them. Within the context of the book, there are many useful suggestions for anyone who is working with members of Hmong families or any family from a culture other than their own. One of the unique attributes of this book is the way in which Fadiman remains unbiased, or at least honest about her biases, towards both sides of the cultural dyad. Fadiman presents the Lee family in a positive light, showing their dedication to and love for their daughter Lia. She presents Lia's doctors in a positive light as well, presenting the reader with displays of their concern and commitment to Lia's welfare. While the information presented in the book would certainly have the most relevance for people working in a medical profession, it carries along many implications for other professionals as well. For speech-language pathologists (SLPs) working with members of a Hmong family, it is important to look beyond the language differences and recognize the cultural differences that will affect treatment at an even more fundamental level. For example, as with many cultures, when discussing something of importance, it is respectful to speak to the oldest male. When speaking through the use of an interpreter, speak to the family, not the interpreter. However, when possible, the interpreter should be bicultural, and be able to act as a cultural informant for the SLP. Perhaps one of the most summative and useful points of the book is when Fadiman discusses the following eight questions used by Arthur Kleinman, a psychiatrist and medical anthropologist from Harvard Medical School. 1. What do you call the problem? 2. What do you think has caused the problem? 3. Why do you think it started when it did? 4. What do you think the sickness does? How does it work? 5. How severe is the sickness? Will it have a short or long course? 6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment? 7. What are the chief problems the sickness has caused? 8. What do you fear most about the sickness? If used correctly, these questions could provide great insight into doing any kind of medical work with patients from a different culture. Many of them can be altered quite easily to fit the clinician-client model that is used for speech language pathology. Had these questions been asked of the Lee family, and the answers to them taken seriously, the outcome of Lia's struggle may have been changed significantly. These eight questions could have also been appropriately applied to Lia's doctors. This may have helped her doctors realize that they approached Lia'

    3 out of 3 people found this review helpful.

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  • Posted October 15, 2011

    Highly recommended especially for healthcare providers

    Love it! It was really educational. I feel like I learned a lot about the Hmong people and their culture and some of the challenges faced in healthcare every day with cultural barriers. As a nurse myself, I sometimes come in contact with patients who are from different cultures and ethinic groups and although my hospital does its best to provide interpreters either via live or phones or videos, there are the rare moments when we simply have no interpreter for a patient and communication becomes a really hassle at that point. I could see clearly relate to both Lia's parents and the doctors and thier struggles. As someone whose first language isn't English, I could realte to Lia's parents'struggles in dealing with a new country and new set of rules and regulations while trying to maintain their own cultural beliefs and practices. As a nurse in the Western World, I could also see the frustrations the healthcare providers were feeling when they thought they were doing their best and from their view points, it appeared that Lia's parents were not cooperating and seemed to be largely ignoring their recommendations in regards to their daughter's health. It was tragic that Lia's live ended up in such a state and I wish I knew what ever happened to Lia and her family after the book ended. Thumbs up to the author for doing a great job! Loved the book!

    2 out of 2 people found this review helpful.

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  • Posted October 9, 2011

    Captivating

    Amazing!

    1 out of 1 people found this review helpful.

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  • Posted July 10, 2011

    Highly Recommend

    One of my all time favorites. I agree, it should be required reading for anybody in the medical field. I can only think to descibe it as a consequence of cultural misunderstanding.

    1 out of 1 people found this review helpful.

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  • Posted April 10, 2011

    Unforgettable

    This is one of my favorite non-fiction books ever. This story will change the way you view the world and other cultures. If you are interested in medicine, anthropology, or a wholly absorbing human interest story, you will not be disappointed.

    1 out of 1 people found this review helpful.

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  • Posted September 19, 2010

    more from this reviewer

    Fantastic Book

    Anyone involved in healthcare should be required to read this book. What an eye opener. Well written and impossible to put down.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 14, 2010

    Wonderful Read!

    Great book, gives great insight into cultural differences and perceptions.
    Was a required reading for one of my classes but it was wonderful!
    Makes you see differences between the American culture and the Hmong people.
    you will enjoy it!

    1 out of 1 people found this review helpful.

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  • Posted July 18, 2009

    Very Interesting and Well-written Book!

    I love this book for its comprehensive dealing with a difficult subject. I liked that there seemed to be no bad side--just different sides that didn't understand each other. With more and more immigrants bringing differing cultural beliefs and expectations, it is a very relevant subject matter. It is one of the best books I have ever read. While I wished for a better outcome, the well-researched info on the Hmong culture was fascinating and well worth the time taken to read.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted June 28, 2009

    A Must Read for Medical Social Workers

    I bought this book for a social work student for her graduation. I am a social worker in a pediatric hospital. This book is so relevant for us because we are confronted with similar dilemmas every day. This book reminds us to take culture into consideration when assessing for medical neglect.

    For general readers, this book is just a great read.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted April 29, 2009

    The Spirit Catches You and You Fall Down

    I had to read this book for a Nursing class. At first I was irritated that I would have to read the whole book as well as the other 2 that came for the class. I started reading this story and I have to tell you that it was hard to put it down once I started it. I read the book in 1 day and reread it again for the class to catch all the details that I missed the first time. I also had to write a case study on the book and that was so much fun. This story tells the real life issues that face immigrants that come to our country and do not speak the language. Most Hmong can not read or write in their own language, for get them using ours. Not all, there are some that have been raised in America and can read and write English very well. I was at the hospital with my family and there was a poster that said "point to your language and we will get you a interpreter". I laughed, most Hmong could not read the sign, even though their language was one of them listed. Anne Fadiman know how to tell a story and the history and research that she did for this book is truely amazing. I wish she would write an update and tell us how Lia Lee is today.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted March 9, 2009

    Excellent

    This book was assigned to me for a course that I took. One of the best assigned readings I have ever had!

    1 out of 1 people found this review helpful.

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  • Posted December 16, 2008

    I Also Recommend:

    Educational

    This is an important book and well written. We had it in college as common reading and I delighted at how easy it was for me to follow. I came away with a greater understanding of the cultural beliefs of the Hmong people. Another exceptional book to read on the Hmong is by Kao Kalia Yang. The book is entitled "The Latehomecomer."

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted September 24, 2008

    An eye-opening account of the Hmong culture

    I felt the author was depicting a culture that was so radically different from America's, that to simply come to America and learn to speak English, wouldn't have sufficed. I don't think the author was biased towards the Hmong. She gave a fascinating account of their very different culture and showed how difficult it was for the parents to deal with American doctors, as well as how difficult it was for the doctors to deal with the parents. I'd highly recommend this book.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted December 3, 2004

    Excellent eye-opener

    This book really makes you think and puts your life into perspective. For a family who cares so greatly for their daughter to keep going during such a difficult time is amazing! I can't imagine being in their shoes.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 9, 2004

    This is a MUST READ in today's nation of diverse cultures.

    As a Hmong woman who was born and raised in the US, this book was an eye opener. Not only did it teach me about my own culture, but it helped me to relate to the difficulties that all minorities in this nation face. Because of my personal experiences, I recommend this to, at the very least, all educators and health care providers. This story is very touching and is indeed, very sad. It's very disappointing that we live in such a free nation, yet we are so ignorant of all the different people and cultures around us.

    1 out of 1 people found this review helpful.

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