The Spirit Catches You and You Fall Down
is based on a true incident that explores the cultural clash between a Hmong
family and an American medical facility. The conflict occurs over the care of a
Hmong baby girl, Lia Lee who was diagnosed with severe epilepsy. Lia’s parents
and her doctors both wanted her to recover but a lack of communication and
understanding between them led to the struggle. Anne Fadiman uses The Spirit Catches You and You Fall Down
to convey the message that no matter how much the Western medicine has
advanced, cultural factors are important for diagnosis, treatment and care.
The Lees
were a Hmong family that lived as refugees in Merced, California. They fled
from their country, Laos due to warfare and political strains. They survived but
half of their kids died during the escape. They also lost their identity as
being self-sufficient, respectful and productive farmers and were forced to
become dependents on Merced economy. Lia Lee was the 13th child born
to mother Foua and father Nao Kao Lee. She was suffering from epilepsy since the
age of 3 months old. She was taken to the emergency room at Merced multiple
times Due to a language barrier the parents could never communicate the symptoms
correctly to the doctors. It was when she was taken into the emergency room
during a convulsion that she was correctly diagnosed with epilepsy.
Lia Lee was
prescribed complex medications by the doctors. Her parents found it difficult
to comply with the instructions. This resulted in Lia Lee being over-medicated,
under-medicated or not medicated at all. Seeing no improvement in Lia Lee’s
condition, her parents believed that huge amount of medicines was doing more
harm to her than good. For them, “the crisis was the treatment, not the
epilepsy” (53). Lia’s condition worsened to such an extent that one of her
doctor’s recommended that she should be taken into foster care. While Lia was
away, the parents went through a rigorous learning session to be able to give
the right medications to their daughter. After they showed ability to comply
with the prescription, Lia was returned to them. Despite being given the right
medicines, Lia’s seizures did not stop. One afternoon, Lia went into status
epilepticus, the situation that was feared by all her doctors in which her seizures
continued one after another without any interval of consciousness. The parents
believed that the child was returned to them in a “damaged condition” (110). The
seizure and the septic shock resulted in Lia’s brain completely losing all its
functions. She went into a comatose stage. Her seizures stopped since she was
brain dead. Her doctors decided to take her off all life-saving treatments because
they knew she was going to die. She had been living in the vegetative state for
two years, much to the surprise of the doctors and was also lovingly cared by
her parents, when Anne Fadiman first visited them.
The Spirit Catches You and You Fall Down
is a literal translation of a Hmong phrase, quag
deb peg. In English, it is translated as epilepsy, a condition well known
to every Hmong. The Hmongs receive this condition with both fear and gratitude.
The condition is a burden on the individual undergoing the seizures and having
hallucinations but the person is blessed spiritually. For the American doctors,
diseases are caused due to changes in the normal functioning of the body and
epilepsy was due to a malfunctioning in the brain activity. It had nothing to
do with the soul.
This book is
an exciting story about the cultural aspect of practicing medicine. Other than
this book, Fadiman has authored two essay books only. I would like to read them
since I like her writing style. She is very clear in what she conveys that
immediately gets into your heart. In Spirit
Catches You and You Fall Down, Fadiman gives vivid descriptions of the war
situation in Laos that resulted in the Hmongs escaping and transitioning into
the Western world. She acts like a cultural broker. She interviewed everyone
involved with Lia Lee’s case, listened to their stories, interpreted what they
believed in and integrated their interpretations with one common goal, to save
Lia Lee.
Despite many clashes of beliefs,
Fadiman did a commendable job in presenting the correct viewpoints of both the
Hmong parents and the American doctors. For instance, Lia’s parents considered
her doctors, Neil Ernst and Peggy Philip guilty of Lia’s status epilepticus
condition. It was not because the doctors had prescribed the wrong medications.
It was because they went on a vacation and left Lia to be cared by other unskilled
doctors. When Neil and Peggy heard this from Fadiman, they were completely
shocked. Even when Lia was taken away into foster care, the parents had no clue
why they were being separated from their child. They threatened to consider
suicide so many times that Fadiman says, “Child Protective Services considered
placing the entire family in a psychiatric hospital” (89). This sentence made
me laugh as well as cry. The Lees were very loving and caring parents but they
were legally declared as “abusive parents” due to their inability to follow the
doctor’s instructions. At the end of the day, Fadiman concluded that everyone
was striving hard to save Lia Lee. They were fighting from different sides but
their ultimate goal was the same.
One of the most powerful incidents
described in the book is when the child of Peggy Philip, one of the doctors of
Lia Lee, was diagnosed with leukemia. Lia’s mother could identify her pain with
that of Peggy’s. They were both hugging and shedding tears over their kids’
ailments despite all cultural barriers. This incident shows the humanitarian
side of both the cultures. There are some feelings that are culturally
universal. This motherly love surpassed any cultural judgments. With this I
believe that Fadiman’s conclusion that the Hmongs are “differently ethical’ is
contradictory. She said so because the Hmongs would cheat creatively on the
written part of the driver’s test and lie about their age and marital status to
gain benefits. This is just a way for the Hmongs to find a place for themselves
in a place where they do not even understand the language. Every culture has a
set of rights and wrongs but the ultimate cause for it is the human desperation
to survive. It should not be considered differently
ethical.
Although the book was very sad, I
found it an interesting read. I learnt a lot about the Hmong culture. Also,
being a pre-medical student, the book compelled me to consider the cultural
aspect of medicine, which is usually taken for granted. It is very important
for doctors to be sensitive to cultural differences and to try to provide care
accordingly. In Lia’s case, a lack of a competent Hmong interpreter was a
disadvantage but the Hmongs are so radically different from the Americans that
even if a good translator were present, it would be difficult to find
appropriate Hmong terms to explain the situations properly. The doctors should
have at least tried to acknowledge the concerns of the Hmong parents. Cultural
barrier in addition to illiteracy resulted in the parents giving wrong
medications to their child. Due to deteriorating condition of Lia, the parents
lost faith in the treatment plan. They believed that Lia needed some
medications but she also needed chants, amulets and animal sacrifices. But for
the doctors, Lia’s parents were the cause of her suffering.
The Spirit Catches You and You Fall Down is not really a “must read” book for
premedical/pre-health students since it does not give a deep insight about the
life and challenges in a medical school but it does enlist some chilling facts
and personal experiences of doctors. It talks about cultural competence which
people in the field of health care have to face in their careers. Winner of the
National Book Critics Circle Award for Nonfiction, the book is based on
well-conducted research about cross-cultural medicine with some very valuable
lessons.
