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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 11 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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  • 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 5 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 January 5, 2003

    Louise, a health care consumer.

    Every health care professional should be required to read this book. The health care culture of this country is difficult for the average american to understand. I can only imagine the terror that the Lee family must have felt as they tried to help their daughter.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted September 6, 2013

    Read this

    One step further in cultural understanding and universal acceptance for all of us

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  • Anonymous

    Posted June 10, 2013

    Engaging

    For those interested in medical ethics, this is a must read!

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  • Anonymous

    Posted February 17, 2013

    I Also Recommend:

    This story graphically illustrates two cultures that meet h

    This story graphically illustrates two cultures that meet head on - with each one having absolutely no understanding of the other. This book will take you on an emotional roller coaster ride, filled with plenty of ups and downs. It is also filled with heartfelt compassion toward the parents and to Lia and at times it is filled with anger toward the parents and to the doctors and staff of Merced Community Medical Center. It is my belief that this conflict between the two cultures was intensified by the fact that the Hmong's entire culture is one that is built on a series of beliefs and superstitions that they use nearly every day to combat illnesses and appearance. For example, the author notes early in the book, "Although the Hmong believe that illness can be caused by a variety of sources – including eating the wrong food, drinking contaminated water, being affected by a change in the weather, neglecting to make offerings to one’s ancestors, being punished for one’s ancestors transgressions, and etc but by far the most common cause of illness is soul loss"(Fadiman, 1997, p. 10). The lack of communication is also a critical factor that shapes this clash of cultures.
    The main characters of this reading are a Hmong child named Lia and her parents Foua and Nao Kao Lee, and the American doctors and the collision/clash of two totally different cultures and beliefs. It was during the Vietnam War that many Hmong were recruited by the United States to fight the North Vietnamese in Laos; after Laos fell to the Communists in 1975, 150,000 Hmong, in fear of their lives, fled the country. Some of them fled their native lands for economic advancements, better education opportunities, a new beginning, and some fled from religious and political persecution. The Lees were among them fleeing but they were turned around at gunpoint by Vietnamese soldiers. Later a successful escape attempt resulted in a 26-day walk to Thailand, where they spent a year in refugee camps and suffered the loss of three of their children while there. In 1980 the Lees finally arrived in the United States along with their seven living children, and little else. Upon arriving in the United States many of the immigrants and refugees have chosen to retain their cultural identity, including their language and cultural practices. These factors have led to an increase in bilingualism and biculturalism which, in turn, has increased the need for successful intercultural communication. But as we will find out in the early eighties at Merced Community Medical Center (MCMD) they lacked any intercultural communication skills, hence the onset of the conflict. It all begins when the Lee’s take their daughter Lia (their fourteenth child and the only one born in a hospital and in America) to the hospital. Initially Lia was misdiagnosed but eventually she was diagnosed with epilepsy, which the Hmong call "the spirit catches you and you fall down" disease and what the American doctors calls seizures. Lia had her first seizure when she was about 3 months old.
    The American doctors and staff had only the child’s best interest at heart but they were unable to properly execute the required care for the child because there was a barrier between the Hmong and American cultures as to how the child should be treated for her condition. The Lee’s have chosen to use spiritual and holistic approaches to their daughter's health problem, reason being is that it was all they knew to do, and on the other hand, the American doctors wanted the Lee’s to use American medicines and treatments to cure their daughter. This here is another part of the conflict because the Lee’s had no idea what these treatments were, or how they would benefit their daughter. The turning point of this seemingly never ending clash of cultures is when young Lia has the worst possible seizure, that being the Grand Mal Seizure. Her doctor had stated that watching her seize was like something out of the Exorcist, she was literally hopping off the table and had been seizing continuously for about two hours (Fadiman, 1997, p. 143). This was her worst seizure ever and this is the one that had everyone on edge and fearing for her life. Although Lia was not expected to live she did. This is the one that left Lia in a permanent vegetative state for 26 of her 30 years of life.
    In summary, the Hmong and others were failed when they attempted to access the Western health care delivery system; they were faced with almost insurmountable barriers especially that of communication. Cultural barriers, including their beliefs about health and illness, were systematically opposed by those of the Western health care professional. They dismissed the alternative views of their Hmong patients and because of this they were not able to effectively care for them because the cultures were at what seemed to be a continual war with one another. What the American doctors probably already knew but did not apply is that culture is learned, not inherited; it is shared by members in a common group; and is transmitted to children by their parents and other adults, not by formal teaching, but by children observing the actions of their parents. Culture sets guidelines for appropriate behavior, styles of thinking and appropriate ways to express emotions. Culture shapes the way we see the world. It shapes our relationships with our nuclear family, kin groups, neighbors and friends. It shapes our economic, political and religious institutions. Above all, culture shapes our beliefs about illness and health, including reasons for the causation of disease, the methods of diagnosis and the appropriate treatment plans (Warner & Mochel, 1998). So hopefully now no child or parent will ever have to suffer from cultural conflicts. Proper ethical training of doctors and staff should alleviate any situations like that of Lia from ever happening again.

    0 out of 1 people found this review helpful.

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  • Posted June 17, 2012

    “The Spirit Catches You and You Fall Down” is a stor

    “The Spirit Catches You and You Fall Down” is a story by the award winning reporter Anne Fadiman, which shows how the differences in culture and beliefs have an enormous effect on one’s life. Fadiman’s story takes place in the popular state of California. The Lee family of the Hmong culture left well populated China to come to one of the most well established countries in the world. While moving to the United States, the Lee’s still thought of their culture and beliefs at an extremely high level.
    Fadiman shows one some important and unbelievable beliefs of the Hmong’s such as them not liking to take orders, that they stick to the customs of their culture at any cost, and the fact of having a difficult time in adjusting to the modernisms of the United States.
    One Hmong family, the Lee family, consisted of twelve children along with the husband and wife. One of their daughters, Lia, had her surprising first epileptic seizure at just three months old. She started to have more but being Hmong, the parents of Lia unfortunately thought this stemmed from spiritual causes. After being diagnosed with epilepsy, the American doctors prescribed numerous amounts of drugs but the Lee family was not administering her drugs correctly. The Lee family not following the procedures because of their beliefs put their daughter in an unacceptable situation.
    Sticking to their beliefs and thinking the seizures were being caused by spirits became a horrible mistake. Lia had not received the proper amounts of the medication that she had been prescribed and needed. Horrifying to hear, Lia was taken from the Lee’s after the doctors found out about the family’s terrifying actions. Lia ended up having a massive seizure and becoming brain dead. This was all because of the spiritual beliefs of the Lee family, one of the Hmong culture.
    With death seemingly to be near, the parents of Lia were still allowed to take her home. The Lee family continued their beliefs and still looked forward to hopefully Lia amazingly becoming healthier. They had always treated Lia differently than their other kids because of their undeniable thoughts that what was happening to her was for a divine reason. Believing Lia was being guided by some spiritual thought backfired on this family dramatically. No matter their beliefs, Lia should have received her prescribed medication and she would have been able to live some sort of a normal life.
    Overall “The Spirit Catches You and You Fall Down” is an outstanding book. It shows the different beliefs that other culture live by and experience on a day to day basis. The Hmong culture has some jaw dropping beliefs but so does every other culture. One thing that should change in our society, no matter where one lives, is the refusal to take what you need to survive. That is selfishness at its highest level to many. Actions of such can have a disturbing and unwanted impact on the people we love in life.

    0 out of 1 people found this review helpful.

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  • Posted March 10, 2012

    The Spirit Catches You And You Fall Down by Ann Fadiman is a tho

    The Spirit Catches You And You Fall Down by Ann Fadiman is a thought-provoking tale of an extreme case of culture clash which eventually leads to tragedy. The story centers around Lia Lee, the American-born daughter of two Hmong refugees who emigrated to America, settling in Merced, California. Lia is an epileptic who frequently suffers intense grand mal seizures. Her parents recognize something is wrong, and seek assistance at the local hospital. However, in their culture, epilepsy is said to be a sign that someone has been chosen as the host of a healing spirit, and is destined to be a ‘txiv neeb’, or shaman. The result is a long saga of frustration on both sides. Lia’s parents don’t speak English, so they cannot accurately regulate her medications and dosages, and do not believe the doctors know what is best for their child. Similarly, the American doctors cannot or will not try to understand the Hmong traditions and beliefs surrounding her illness. Social services ends up involved, and Lia’s story ends in heartbreak for all those who were just trying to do what they thought was best for her. The main themes in this book include cultural assimilation, the clash between traditional holistic medicines and Western medicine, and the dominant nature of American society. To what degree should immigrants be expected to conform? Can it be considered child abuse for these people to take care of a child based on their beliefs, regardless of whether it’s assisting the child or not? Does the Western world believe their culture is superior? These are the questions readers of the book are forced to ask themselves. I personally enjoyed this novel because of its compelling nature. Having grown up in a middle-class, mostly white society, I’ve never had much experience with the topic of culture class. Ann Fadiman made me take an introspective look at my own culture and it’s flaws. The only complaint I have is that at times, the author’s personal bias on these issues is evident; she should have left it up to the reader to decide who they sympathized with. I would recommend this book to others because I think that being forced to re-evaluate the culture we live in, and the things we take for granted, like compliance with our medical system, could be beneficial to anyone who, like me, grew up with a typical American lifestyle. If this topic is of interest to you, another book you may like is The Scalpel and the Silver Bear by Lori Alvord and Elizabeth Cohen Van Pelt. The theme of culture clash is again explored here, when Alvord, a surgeon, struggles to help the people of her Navajo reservation accept Western medicine while maintaining the traditions of their healers and remedies.

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  • Posted June 14, 2011

    What+an+insight%21

    I+was+married+to+a+Hmong+shaman+for+12-1%2F2yrs+and+this+book+thoroughly+gives+insight+to+who+the+Hmong+are+and+what+they+believe.+It+follows+their+struggles+with+not+only+language+barriers%2C+but+how+they+view+the+body+and+spirit+as+one...+much+more+holistic+than+general+practitioners.++Western+medicine+is+beginning+to+re-incorporate+some+of+thei+beliefs+back+into+treatment+of+all+patients.%0A%0ASeeing+how+close-knit+the+Hmong+communities+and+clans+are+and+how+they+struggle+to+keep+their+heritage+alive+in+foreign+lands+only+gives+me+a+deeper+respect+for+the+people.++This+book+reads+like+a+novel%2C+yet+is+very+accurate+with+even+the+most+minute+details.++I+have+recommended+it+to+several+people%21%0A

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  • Anonymous

    Posted October 5, 2003

    a must reference book for all health caregiver

    As a health caregiver myself, it definitely has given me an indepth insight on cultural barrier, therefore making my care more effective. I have recommended this book to my coworkers but I also wish non-health care workers find time to read this book to make them aware of how great of an impact you would make to a person of a different culture if you have broader understanding of their belief system.

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  • Anonymous

    Posted April 28, 2001

    okay....

    oops, i apologize for some stuff i have said about this book... i guess i was right when i say my parents haven't taught me everything about the hmong culture... gosh, i'm kinda emberass about the fact that i thought i knew everything about my own culture and that the author don't... i found out that her part about the way pregnant women have to eat what they crave for is right and that some people do sacrifice cat... it's just that all the hmong people i knoe don't sacrifice cat, so to me it's not true to me, i guess.... sorry... this book IS actually really okay... maybe i should really consider reading the rest of it before i give my opinion, hehehe... so, give the book a try, you might learn some new things that will take u by surprise, like for me!

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