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

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

4.1 128
by Anne Fadiman

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ISBN-10: 0374267812

ISBN-13: 9780374267810

Pub. Date: 09/30/1997

Publisher: Farrar, Straus and Giroux

Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees


Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg—the spirit catches you and you fall down—and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.

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Farrar, Straus and Giroux
Publication date:
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6.40(w) x 9.58(h) x 1.18(d)

Table of Contents

Preface vii

1 Birth 3

2 Fish Soup 12

3 The Spirit Catches You and You Fall Down 20

4 Do Doctors Eat Brains? 32

5 Take as Directed 38

6 High-Velocity Transcortical head Therapy 60

7 Government Property 78

8 Foua and Nao Kao 93

9 A Little Medicine and a Little Neeb 106

10 War 119

11 The Big One 140

12 Flight 154

13 Code X 171

14 The Melting Pot 181

15 Gold and Dross 210

16 Why Did They Pick Merced? 225

17 The Eight Questions 250

18 The Life or the Soul 262

19 The Sacrifice 278

Afterword to the Fifteenth Anniversary Edition 289

Note on Hmong Orthography, Pronunciation, and Quotations 305

Notes on Sources 307

Bibliography 327

Acknowledgments 341

Index 345

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Spirit Catches You and You Fall Down 4.2 out of 5 based on 0 ratings. 128 reviews.
Guest More than 1 year ago
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.
HEDI09 More than 1 year ago
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!!
ElaineT More than 1 year ago
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.
nprfan1 More than 1 year ago
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.
Guest More than 1 year ago
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'
FB80 More than 1 year ago
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!
Kidzmom More than 1 year ago
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.
Anonymous More than 1 year ago
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.
Guest More than 1 year ago
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.
Guest More than 1 year ago
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.
Guest More than 1 year ago
The Spirit Catches You and You Fall Down is a beautifully written book about a culture that very few people know anything about. As a Puerto Rican with working-class roots, I can relate to the clash of culture and the problems with which immigrants/emmigrants must grapple in different hierarchical structures. Those qualities that gain respect for a family in a poor, rural village receive no admiration in the US, and the loss of respect and social status is quite painful. In a country of experts where a listing of one's degrees is all-important, individuals from oral cultures become invisible. The physicians who worked with the Hmong did not think they needed a translator because the doctors, with their deified positions in US society, did not think they could learn anything from the 'primitive' culture of the Hmong. However, all of life is observation and who could be more observant than people whose very survival is dependent upon their powers of observation. And science is based upon observation. But the physicians could not dream of having a reciprocal relationship with persons who were not published in medical journals and could not read numbers on a thermometer.
Alison Herold More than 1 year ago
MsDebee More than 1 year ago
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.
NancyDrew2 More than 1 year ago
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.
Wagnuts66 More than 1 year ago
Anyone involved in healthcare should be required to read this book. What an eye opener. Well written and impossible to put down.
Anonymous More than 1 year ago
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!
Anonymous More than 1 year ago
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.
Anonymous More than 1 year ago
This book was assigned to me for a course that I took. One of the best assigned readings I have ever had!
Robert_Pen More than 1 year ago
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."
Guest More than 1 year ago
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.
Guest More than 1 year ago
Anne Fadiman does an excellent job in writing this book. Her style and grace made it all the better. I also wanted to recognize her impartialness when describing both the doctors and the Lee family. Anybody in the healthcare industry would benefit from reading this book.
Guest More than 1 year ago
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.
Guest More than 1 year ago
I read this book a few years back to do a paper on social problems. Being Hmong and raised in America, I thought this book did a good job of bringing to light the problems that are so common among many Hmong families and western medicine. I have had my own experience with this issue. My mother would rather suffer the pain of gall stones than to have her gall blatter removed because she was worried that she woudln't be complete when she dies and therefore couldn't enter the afterlife. Reading this book, I realize how crazy some of it may sound to an American because I'm Hmong and it's crazy to me. But it is my reality. This is a real issue and I hope that through books such as this, we can work on our parts to come to a civil solution. I highly recommend this book.
Guest More than 1 year ago
This thoroughly fascinating book is a must read for anyone interested in accounts of the collision of cultures that often ensues when immigrants arrive in America. The author has taken the time and energy to give us, not just an engrossing and tragic tale, but also very detailed and fair portraits of the people involved in it. It would have been so much easier for a lazy author to use this story to demonize the California medical system. Instead, Anne Fadiman gives us an even-handed, thoughtful account of how people of two very different cultures were forced to interact ¿ an unparalleled piece of investigative journalism.
Anonymous More than 1 year ago