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The Spirit Catches You and You Fall Down (1997)

by Anne Fadiman

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recommended for: anyone who has interest in understanding people different from them

I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well. Not that I didn’t feel angry (and amused) at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman’s account of the events. My culture is definitely that of an American (well, a subculture anyway, as there are obviously many cultures within America!) and I am fairly wedded to it, but I really appreciated this look into a culture so different from my own.

Anne Fadiman does a remarkable job of communicating both sides of this story; it’s probably one of the best examples of cross-cultural understanding that I’ve ever read. It’s ostensibly about a young Hmong girl with epilepsy and her family’s conflict with the American medical establishment, and there is much about them here.

But it’s also a wonderful history book. There’s much background about the Hmong people going back centuries and recent history also. It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland.

I learned so much about the Hmong people; I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context. And, as I was reading, I was really struck by how cultural differences (and the cultural differences between the Hmong and American cultures is about as far apart as it gets) can completely hinder communication if they’re not acknowledged and attempts are made to bridge the gap. This is a great book to read if you want to try to understand any people who are different from you in any way.

Beautifully written and an enjoyable read. ( )
2 vote Lisa2013 | Apr 15, 2013 |
Read for Anthropology. Fascinating story of the conflict between a Hmong family and the doctors treating their daughter for severe epilepsy. ( )
  maureene87 | Apr 4, 2013 |
Anne Fadiman is, quite simply, one of the best writers I have ever read. In The Spirit Catches You and You Fall Down, she zeroes in on a little-known minority, the Hmong, many who fled Southeast Asia and settled in the U.S., where cultural misunderstandings - especially in the medical sphere - have had drastic results. Fadiman focuses on the specific case of Lia Lee, weaving it in with general Hmong history, culture, and mythology. She has done extensive research and interviews, getting to know her subjects well and building a bond of trust, which is reflected in her writing - clear, sympathetic, piercing, and, at times, dryly humorous.


...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... (13)

The Hmong never had any interest in ruling over the Chinese or anyone else; they wanted merely to be left alone, which, as their later history was also to illustrate, may be the most difficult request any minority can make of a majority culture. (14)

...in one of those unconscious processes of selection that are as mysterious as any other form of falling in love, it was obvious that Lia was her parents' favorite... (22-23)

...gallows-humor slang wielded in times of extreme stress on the theory that if you laugh at something it can't break your heart. (173)

"I am the chameleon animal. You can place me anywhere, and I will survive, but I will not belong. I must tell you that I do not really belong anywhere." (249)

Among the resources suggested by the guidelines' authors was...a simulation game in which the participants are divided into two mythical cultures, each assigned a different set of manners, conventions, and taboos. Each group inevitably misperceives the other by applying its own cultural standards; each inevitably offends the other; and each, until the groups meet at the end of the game to discuss the pitfalls of ethnocentrism, is inevitably certain that its culture is superior. (271) ( )
  JennyArch | Apr 3, 2013 |
This is what all non-fiction should aspire to be. Fadiman does an amazing job of introducing the reader to the intricacies of the Hmong culture, as well as taking a third-person look at the "clash of cultures" between the Lee/Yang family and the Merced medical community. I couldn't put this book down. It's a must read for anyone working with immigrant cultures or in cross-cultural settings. It really puts a magnifying glass on the importance of cross-cultural competency and communication and emphasizes the need to think outside of a Westernized worldview. ( )
  Firecrackerscribe | Apr 2, 2013 |
A story about both sides of a little girl's illness. Lia Lee started having epileptic attacks at 3mos old. Anne Fadiman examines both the Western Medicine and the Hmong Culture that that failed her.

And really neither failed. But neither succeeded. I learned alot about how Western Medicine views a patient. And if that patient is a child, how it views the family. I also learned about how the Hmong have survived thru the centuries, never assimilating into the culture of any country they have lived in. They have been nomadic and have no homeland. The Hmong have chosen to live in remote mountains, far removed from the rest of the world. No country has wanted them to stay b'c of this non-assimilation. But they have used the Hmong to fight their wars.

Anne Fadiman does an amazing job of showing both sides of Lia's illness. She shows great care in trying to understand the culture of both and find the reason they failed together. She enters their worlds on their terms and has great understanding on how they both tried their best to help Lia.

Really interesting book. ( )
  purlewe | Apr 1, 2013 |
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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)
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"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.

Commentary:
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, 03 Jan 2013 06:33:35 -0500)

(see all 4 descriptions)

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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