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The Spirit Catches You and You Fall Down by…

The Spirit Catches You and You Fall Down (1997)

by Anne Fadiman

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So much to learn about events that were going on that I would have liked to know about, but did not. The Hmong are fascinating people, that I am glad that I have now met through this book, and about whom I intend to continue learning ( )
  Lylee | Apr 3, 2016 |
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
( )
1 vote SheTreadsSoftly | Mar 21, 2016 |
The youngest child of Hmong immigrants has severe epilepsy. Fadiman starts telling that story, then doubles back to tell the reader about the history of the Hmong people and their beliefs. Then she resolves Lia's story, tracing her passage through the medical and foster care systems. It's beautifully, comprehensively researched and told with clarity and fire, but it's also a very frustrating tale. Because while the intersection of two wildly different cultures is fascinating, the end result is that pretty much everybody involved was hurt by the collision. ( )
  wealhtheowwylfing | Feb 29, 2016 |
great story - kinda werid how every other chapter was a different perspective, because I would just be getting into the chapter then it would change. ( )
  katieloucks | Feb 26, 2016 |
Such a sad, unfortunate account of two cultures colliding with ensuing misunderstandings resulting is tragedy. There is much to be learned from this account. I found the description of Hmong culture fascinating and find it disturbing that relocation to the US will likely erode away a culture that had managed to survive in the remote regions of Asia. ( )
  Cricket856 | Jan 25, 2016 |
Showing 1-5 of 90 (next | show all)
If tragedy is a conflict of two goods, if it entails the unfolding of deep human tendencies in a cultural context that makes the outcome seem inevitable, if it moves us more than melodrama, then this fine book recounts a poignant tragedy.
Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different.
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If Lia Lee had been born in the highlands of Laos, where her parents and twelve of her brothers and sisters were born, her mother would have squatted on the floor of the house that her father had built from ax-hewn planks thatched with bamboo and grass. (Chapter 1 - Birth)
"Of course, Martin had undergone an equally unseemly metamorphosis himself, from savant to bumbler.  It was as if, by a process of reverse alchemy, each party in this doomed relationship had managed to convert each other's gold into dross."  pg. 223
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Genre: non-fiction

Summary: A child of a family of Hmong Immigrants to the US has epilepsy, and cultural misunderstanding contributes to overmedication, culture clash, and a tragic result for the young girl.

The group read this along with Linda Voigt's "Bodies," an excerpt from article on Medieval Model of the Humours

The group responded enthusiastically to the Fadiman book, especially its fair-minded and balanced presentation of both the Hmong and the American medical perspectives on the case of epilepsy patient Lia Ly.

While there was much sympathy for the devastation wrought by the language barrier when two such different cultures collide, there was a sense that things have improved, at least a little, in health care facilities over the past twenty years. "We have learned something" was said a couple of times, referring to the need for intercultural understanding.

The materials on the humours -- which were thought to control bodily health, personality, and one's position in the world -- was a revelation to some participants. I had included it to make the point that, until the 17th century, the Western European model of the body and its functions, the psyche, and the relation of the individual to the cosmos, would be as alien to modern Americans as the Hmong model is.

After the first session in which individual difference was emphasized, this session on cultural differences seemed a logical development in the seminar themes. Many participants commented in later sessions how much The Spirit Catches You meant to them -- how it helped them step back from a cross-cultural therapeutic encounter to assess whether they were really understanding what was going on or what the client was trying to say. (Kathy Ashley, Maine)
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Amazon.com Amazon.com Review (ISBN 0374525641, Paperback)

Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty--and their nobility."

(retrieved from Amazon Thu, 12 Mar 2015 18:06:27 -0400)

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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 were part of a large Hmong community in Merced. 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 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 and 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.… (more)

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