Friday, April 22, 2011

The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman
Farrar, Straus and Giroux, Copyright 1997
Trade Paperback, 360 pages
ISBN-13: 9780374525644
Very Highly Recommended

From the Publisher
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.

My Thoughts:

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
by Anne Fadiman is a balanced account of the clash between a Hmong family and Western medicine. Fadiman follows how the medical community handled or mishandled the case of Lia Lee, and her parents Nao Kao and Foua, a Hmong family. She also follows the history of the Hmong.

The Lees immigrated to Merced, California, from Laos in 1980. At three months old, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, "the spirit catches you and you fall down." The problem was that, to put it simply, the medical community and the family were unable to understand each other.

The problems went beyond a simple language barrier. In addition to the language barrier, there was no understanding of religious or social customs. It was a complete cross-cultural failure on all levels.

Lia's anti-convulsant prescriptions changed 23 times in four years, which would put a strain on any family. And just like, in my opinion, any family, the Lees were sure the medicines were bad for their daughter. The difference is that most American families could question their doctors and make their feelings known. The Lee's were unable to communicate their displeasure with the medication. Even when the medical community wrote down prescriptions or amounts for the Lees, they had no idea that the Lees could make no sense of the numbers and letters. Additionally, the Lees would have liked to address the spiritual connections they felt were essential for Lia's healing.

Lia's doctor, rather than finding a way to work with the Lees and make sure Lia received her medication, reported them for "noncompliance" and child abuse. Lia was placed in a foster home. Lia's parents and her doctors both wanted what was best for Lia, but the misunderstandings between them led to tragedy. When Lia's death was believed to be imminent, the Lees were permitted to take her home. Two years later, Fadiman found Lia being lovingly cared for by her parents, who were still hoping to reunite her soul with her body.

Winner of the National Book Critics Circle Award for Nonfiction, my edition of The Spirit Catches You and You Fall Down includes: a preface; notes on Hmong orthography, pronunciation, and quotations; notes on sources; chapter notes; a bibliography; acknowledgments; an index; and a reader's guide.

I have had The Spirit Catches You and You Fall Down sitting on my shelf, waiting to be read for four years. Shame on me. This is a beautifully crafted, careful study in cross cultural medicine. While it would be very easy to take a "side", Fadiman is extremely even handed. She presents the facts, acknowledges short comings on both sides, and somehow tells the whole tragic story without any condemnation. This should be a must read for anyone in the medical field.

Very Highly Recommended - one of the best


...I had come to Merced, California, where they lived, because I had heard that there were some strange misunderstandings going on at the county hospital between its Hmong patients and its medical staff. pg. viii

Foua conceived, carried, and bore all her children with ease, but had there been any problems, she would have had recourse to a variety of remedies that were commonly used by the Hmong, the hilltribe to which her family belonged. If a Hmong couple failed to produce children, they could call in a txiv neeb, a shaman who was believed to have the ability to enter a trance, summon a posse of helpful familiars, ride a winged horse over the twelve mountains between the earth and the sky, cross an ocean inhabited by dragons, and (starting with bribes of food and money and, if necessary, working up to a necromantic sword) negotiate for his patients’ health with the spirits who lived in the realm of the unseen. A txiv neeb might be able to cure infertility by asking the couple to sacrifice a dog, a cat, a chicken, or a sheep. After the animal’s throat was cut, the txiv neeb would string a rope bridge from the doorpost to the marriage bed, over which the soul of the couple’s future baby, which had been detained by a malevolent spirit called a dab, could now freely travel to earth. pg. 4

The Hmong have a phrase, hais cuaj txub kaum txub, which means "to speak of all kinds of things." It is often used at the beginning of an oral narrative as a way of reminding the listeners that the world is full of things that may not seem to be connected but actually are; that no event occurs in isolation; that you can miss a lot by sticking to the point; and that the storyteller is likely to be rather long-winded. pg. 12-13

The history of the Hmong yields several lessons that anyone who deals with them might do well to remember. Among the most obvious of these are that the Hmong do not like to take orders; that they do not like to lose; that they would rather flee, fight, or die than surrender; that they are not intimidated by being outnumbered; that they are rarely persuaded that the customs of other cultures, even those more powerful than their own, are superior; and that they are capable of getting very angry. Whether you find these traits infuriating or admirable depends largely on whether or not you are trying to make a Hmong do something that he or she would prefer not to do. Those who have tried to defeat, deceive, govern, regulate, constrain, assimilate, intimidate, or patronize the Hmong have, as a rule, disliked them intensely. pg. 17

They recognized the resulting symptoms as quag dab peg, which means "the spirit catches you and you fall down." ..... In Hmong-English dictionaries, quag dab peg is generally translated as epilepsy. It is an illness well known to the Hmong... pg. 20

They therefore hoped....that the quag dab peg could be healed. Yet they also considered the illness an honor. pg. 22

Neil sent a copy of this note to the Health Department and to Child Protective Services. In it he also wrote that:
"because of poor parental compliance regarding the medication this case obviously would come under the realm of child abuse, specifically child neglect....It is my opinion that this child should be placed in foster placement so that compliance with medication could be assured." pg. 58-59

Ever since they had arrived in the United States, the Lees had been meeting Americans who, whether because of their education, their knowledge of English, or their positions of relative authority, had made them feel as if their family didn't count for much. Being belittled is the one thing no Hmong can bear. pg. 96-97

"Suddenly, Lia was, as Bill Selvidge once told me dryly, "just the sort of patients nurses like." she had metamorphosed from a hyperactive child with a frightening seizure disorder and inaccessible veins into an inert, uncomplaining body who would probably never need another IV. Simultaneously, in the eyes of the family practice staff, her parents were miraculously transformed from child abusers to model caregivers. pg. 214

However, I have come to believe that her life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding. pg. 262


Thoughts of Joy said...

I've been wanting to read this for years. Thanks for the reminder! :)

Lori L said...

That's exactly what I kept saying too... Trust me, read it! :-)