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The Spirit Catches You and You Fall Down

A Hmong Child, Her American Doctors, and the Collision of Two Cultures

By

Anne Fadiman

Book Review

Publisher: Noonday Press 1997

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“The Spirit Catches You and You Fall Down” may seem to be a gothic book from its title, about

any non-human spirit attacking humans, but this little non-fiction book has brought marvelous

changes to the world. This small reality based book has changed the world more than any other

book. This book is a piteous story of a young Hmong girl, who suffers from epilepsy and is

caught in the cleft between her family and her positivist American doctors. The story shows the

tragic consequences of lack of cross-cultural communication and reveals the weakness of

western culture in caring for patients with beliefs that they are different from that of their

doctors. The title purely is the other name of seizures and seizures are call

“The Spirit Catches You and You Fall Down” by the Hmong people.

The book has been written by “Anne Fadiman” who is a journalist by profession and bears the

genetics of writing transmitted from her father, Clifton Fadiman. Her father is a well-known

writer. The author, Anne Fadiman, initially intended to write an article about Lia Lee but due to

rejection from The New Yorker she made up her mind to turn her article into a complete book.

The book was published in 1997 and this realistic life changing book was good enough to win

numerous awards including the National Book Critics Circle Award, the Salon Award and the

list goes on. After getting a considerable number awards, this book was selected as the best book

of the year by a huge number of publishers including New York Times Notable Book.

Interestingly the book has sold over nine million copies which prove its success in literary world.

“The spirit Catches You and you Fall Down” is the reverting narrative of showdown between

modern American Medicine and ancient Hmong beliefs, it depicts battle fought over the body

and soul of a very sick Hmong girl. The foremost duty and obligation of Hmong is the following

of their culture. Farming is one of the important duties of Hmong People. These people have no
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concern with the modernity of life. They need some separate land to practice their religious

obligations. On the other hand, Modern American Medicine is very simple unlike Traditional

Hmong Medicine. In America, when a person falls sick, the regular person would go to a doctor,

either at a clinic or the hospital and the doctors would just diagnose him and prescribe medicine

without discussing anything about the spiritual condition of mind.

The author, Anne Fadiman displays well balanced and completely unbiased views of events of a

Lia story through compassion and fair presentation.

Being neutral and unbiased with American Doctors and sick girl’s family, Fadiman clearly

evaluates every angle of a complex situation, while challenging perspectives of her readers about

medicine and spirituality. At the end of eighteenth chapter, Sukey Waller asks, "Which is more

important, the life or the soul?” As per my personal opinion I strongly believe that soul is more

important because life is about material things and soul belongs to spirituality and spirituality

belongs to god. Life can end but soul has to stay with god because there is life after death.

The book depicts spectacular piece of literary work about realistic events of two different

communities. The book is a loveable piece of writing highlighting realistic events but there are

some minor issues I noticed while reading and evaluating the author’s writing style and depiction

of plot.

“The Spirit Catches You and You Fall Down” is a master piece of writing which covers a wide

range of ideas and the book gives raise to large discussions. The author of the book does

masterful job of conveying the tension between two extremely different cultures, by narrating a

sad, pinching, frustrating, and heart touching story of young girl who falls prey to sever medical

conditions that look impossible to cure and manage.

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“Each had accurately noted the same symptoms, but Dan would have been surprised to hear that

they were caused by soul loss, and Lia's parents would have been surprised to hear that they

were caused by an electrochemical storm inside their daughter's head that had been stirred up

by the misfiring of aberrant brain cells.”

In the aforementioned quotation, it very much evident that both the medical workers and the Lia

Lee’s parents are standing on the opposite sides understanding medical condition of the young

girl. This shows the different knowledge and different sense of judgment.

“Dan had no way of knowing that Foua and Nao Kao had already diagnosed their daughter's

problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no

way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological

disorders.”

In the aforementioned quotation it is evident that the book displays a cross-cultural state where

there are extreme differences in the beliefs, way of lives and medication treatment system. Both

try to overlap which leads to the actual problem. The average doctor could learn the true power

of a healthy mind and optimism. The medical doctor might learn from the Hmong that how

doctors’ positive attitude can help patients’ health. One the other hand, Shaman might learn some

basic scientific methods of medicine, which might explain to the Hmong why doctors make

decisions that the Hmong don’t. More so, in the book, the author, describes cultural collision by

explaining the experiences of Lee family in the United States.

Throughout the book the author stays unbiased and presents Hmong people and American

medical professionals fairly by demonstrating empathy and sensitivity to each perspective.

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Culture is an important aspect of discussion in the book “The Spirit Catches You And You Fall

Down”. Being a non-modern culture, the people of Hmong Family believe that

“All the ailments cause by some spirits”.

For them all the disease can be cured through traditional forms of healing. A tvix neeb could heal

disease even more powerful. The tvix is considered to be the cure of getting rid of evil spirits and

retrieving lost souls. There are numerous cultural aspects of Hmong culture such as taboos

against medical science, beliefs about starting of an ailment, patriarchal structures within the

family, often contradict with the culture of Western medicine, which could result in

misunderstandings between the parents and doctors. (As in the Eighteenth chapter of the book

Fadiman writes, as William Osler said “Ask not what disease the person has, but rather what

person the disease has”. The events of the book may have been unfolded differently if Osler’s

dictum were universally followed in the medical field because then the Lee’s would not have

received such special treatment from the hospital staff because they are not Americans. The

Lee’s would have been perceived as immigrants who do talk in English and then therefore,

according to Osler’s dictum they would not have get any kind of help they needed.

Apart from medical and disease aspect the Hmong people have conflicts with their neighboring

American based on shamanic ceremonies.

Fadiman writes this book not only to highlight medical condition but also to enlighten social and

cultural superiority over each other by both of parties. Lia Lee’s medical complications put Lee

family and MCMC doctors in grief and uncertainty situation and in order to cope up with

uncertainty situation, Lee family and doctors try to assign blame on each other. In the uncertain

and critical condition of the child, both the parties seek to decide if the other party acted
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unethically, this is because of the power and blame game. Throughout the book medical team

feels disrespected and undervalued by the Hmong for not fully acting upon the medical advice.

On the contrary the Hmong get angry for the dismissal of their traditional beliefs. This shows

blame game and power theme in the book. In the preface, the author questions herself about

“good teacher” and “good doctor”. The writer could answer her questions by learning that a good

doctor is the one who could do anything in his power and knowledge to help patients. Similarly,

a good parent could be the one who takes the best care of his child and putts his sincere efforts to

the upbringing and this is what my opinion would be about a “good doctor” and “good parent”.

So good parents and doctors would definitely not have disputes and power based on ethnic

groups as it is quoted below.

“What the Hmong wanted here was to be [...] clustered in all-Hmong enclaves, protected from

government interference, self-sufficient, and agrarian”

In the above mentioned quote it is highlighted that Hmong are entirely different from the

Americans. Regardless of the advancement in the world, they need some piece of land to practice

their religion. Unfortunately, that's a dream that simply won't come true as long as they're in

America. This purely shows power theme.

In the critical condition of their child Lee, both the parties feel that their authorities are

threatened and they take it as life-or-death matter. More so, the author places the Western

Medicine and Hmong in non-hierarchal comparison and derives out that the main cause for Lia’s

condition is the failure of two systems to be effectively reconciled and mixed up.

The American Medical Culture and The Hmong Culture are on two poles and do not share

anything. The American Medical Culture is very scientific. All the ailments that we experience
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are diagnosed using scientific methods and treated with the knowledge of viruses, bacteria, the

human body, etc. The Modern American Culture does not believe in non-scientific causes of any

ailment but this system believes in logic and reasoning. On the contrary, In Hmong Culture the

concept of medicine is totally different. Rarely if medicine is made, that is made with plants and

shrubs only but most of the ailments are cured by spirits. That is why the tvix neeb is the most

important way of curing people. They perform the ceremonies that will trick dabs (predatory

spirits) into returning human souls, find souls from where they have wandered off to, or repair

damaged souls.

When it comes to evaluation of this book, it is significant to look at the writer’s motive to write

this book and the extent of achievement in the purpose. The first and foremost motive of Anne

Fadiman to write this book is derived through the four-lined poetry she wrote when she first met

Lia Lee in 1988, she wrote down her impressions the observations in four spare lines that are

now read as a famous piece of poetry.

“Barefoot mother gently rocking silent child

Diaper, sweater, strings around wrist

Like a baby, but she’s so big

Mother kisses and strokes her”

Her motivation to write this book falls under the time she spent with Lia Lee and by observing

her. The aforementioned poetry explains her motivation as she sees her mother looking after her.

Sympathies for the child girl and her family are also one of the motives of her writing. Lia Lee’s

miserable medical condition, the cultural clash between the medical staff and the Hmong family,
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misunderstandings, blame game and ultimately tragic death of the innocent soul are on the top of

the list that provoked Anne Fadiman to write this book. More so the book also has a purpose to

criticize the cultural chasm and animist beliefs.

When it comes to evaluate the achievement of the purpose, it is very much evident that the author

has successfully achieved her motive to a large extent. The book has won several awards and has

been made part of curriculum of different medical, social science and behavioral sciences’

curriculum. The book also sets new trends in the field of medical and culture and the amalgamation

of culture and medicine is now considered an important aspect in any patents’ treatment. There are

numerous audiences of this book which prove that the purpose of the book is fulfilled. The

audience that can gain from this book the most are practitioners, anthropologists, social workers

and policy makers, health practitioners and doctors. The health practitioners could learn about

the different backgrounds and illness treatments. Especially the doctors could find the most from

this book by looking at ways to handle differences in beliefs and healing systems. Overall, the

author, Fadiman, has approximately achieved all the motives through the lens of text of this

book.

The book is a master piece as expected. The title of the book explains much about the topic but

going into the details makes a reader even catchier. The book is very influential and has changed

my view point about the patients, too. The book has changed my personal perception about the

treatment of patients from different backgrounds. I now have a strong intention to understand

and help all the patients from diverse background. The patient is patient and the relation of

humanity is above all the cultural or ethic diversities. The characters of the book are realistic and

the plot is very much close to real life incidents. As far as the information is concerned, the book
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contains enough knowledge to convey the main idea of the book. On the contrary the book has

some repetitions about the history Hmong People which makes it a bit boring.

“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”

As it is very much evident in the aforementioned quote that the author of the book lays emphasis

on the history and attributes of the Hmong which makes this book a bit boring an diverts it from

the central idea of the Lia Lee’s sever medical conditions.

In the conclusion it is significant to discuss that this book has played a vital role in changing

lives of people. The book not only throws light on medical condition of young girl Lia Lee, but

also highlights how cultural differences affect the treatment of a patient. The Lia Lee’s family

belong to the Hmong and have animist beliefs against modern American doctors who also have

cultural grudges for them. Throughout the book, the social, cultural and ethnic issues are

highlighted and related with Lia Lee’s severe medical condition. The most important finding of

this book is cross-cultural clash between the Hmong and the modern doctors. The cross-cultural

clash proves to be the real cause of death of innocent soul Lia Lee. Another important finding is

the undervaluing of the Hmong and doctors for each other leads to even worse condition of

seizures of Lia Lee. The actual cause for the extreme seizure and ultimate death of Lee might not

be due to the over usage of medicine or use of tvix neeb treatment, but the real cause, in

accordance to my opinion, is the lack of mutual co-operation between the medical professionals

and the Lee family.

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More so, I thought of the book to be good and the book meets my expectations and even this

book changes my view about the ethnic diversities. The book perfectly describes the realistic

events of Lia Lee’s life but deep emphasis on the history and attributes of Hmong makes it a

little boring. Lastly, the author has been successful in achieving the motive of writing this book

because a large number of institutions and medicine industries are lying great emphasis on

accepting the diversities in medicine field and making the bond humanity stronger by serving

one another by love.