The first, spontaneous reaction with regard to the stranger is to imagine him as inferior, since he is different from us.

The Spirit Catches You and You Fall Down by Anne Fadiman is the story of the infant daughter of Hmong refugees and how misunderstandings on both the side of the parents and of the American medical community led to tragedy. Lia Lee had severe, hard to control epilepsy. Her parents brought her to the hospital many times but were unable to communicate with the medical professionals caring for her due to both linguistic and cultural barriers. The result was that Lia did not receive the care she needed, and her family, as well as the Hmong community, were given ample reason to distrust American authorities.

The first half of this book was the amazing story of what happened. It's strength was that it was clear that from the beginning everyone wanted to do what was right. Her parents loved her and were excellent caregivers. Her doctors were dedicated and professional. Nevertheless, they spent much of the time in conflict, fatally separated by differences of beliefs and traditions. I appreciated Fadiman's telling of the story, which was both compassionate and impartial.

She lost that strength a little in the second half of the book, which detailed the history of the Hmong people and why they emigrated to the United States and why they didn't integrate in the way expected of them. In a nutshell, the US used the Hmong in their "quiet war" in Laos, bombing their villages and jungle environment into a wasteland, then leaving most of them to their fate when we pulled out of South East Asia. Many escaped across the Mekong river and settled in refugee camps in Thailand. The American government reluctantly allowing them to come to the US when Thailand shut the camps down. The Hmong didn't want to come, but there was truly nowhere else they could live. They believed that their wartime service had earned them a degree of thankfulness from the Americans, and we wondered why they were given welfare out of our tax dollars. It was a fascinating history, well-told, but in the telling she lost a little of the impartiality that had marked the first half. Maybe she had no choice; this wasn't a case of a story having two sides--we destroyed their way of life, while they fought valiantly on our side, but when the war was over we were resentful of our responsibility. And as Americans, we are often too attached to our melting pot view to allow immigrants to keep their way of life. I did agree with her views, I just felt a little preached to, which is never fun, even when you agree with the preacher. ( )

Superb. I can see why Robert Coles compares this to James Agee's and George Orwell's journalism. Excellent cross-cultural analysis of several different cultures--Hmong, medical field (including differences between clinics and hospitals), social workers, CPS, interpreters, &c.--by way of first learning why it's important to examine one's belief systems. I love the Arthur Kleinman quote at the end: "Get rid of the term 'compliance.' It's a lousy term. It implies moral hegenomy." This is a full, well-written, well-researched "narrative" and not a "case study." Reminds me why it's important to: listen, pay attention, to always question one's own assumptions, especially when dealing with another culture. But doing that is not always enough or easy. (This also parallels my thoughts on watching The Wire: there is no simple good/evil dichotomy here--people are often stuck within their institutions and thus certain belief systems without knowing it. Fadiman does a masterful job of interweaving all the different perspectives at the same time questioning her own and watching her own views change over time. Important work for therapists, social workers, of which I am. I like her discussion on the use of cultural brokers v. interpreters. ( )

Amazing book! Essential reading for all medical personnel. This deals with a traditional Hmong family and their disastrous experience with the American health care system. ( )

It was a long time ago I read this book, but I do remember it being powerful and eye-opening. Great story and well-written; I was teaching Hmong children at the time, and it gave me some interesting insights into that culture. I'll probably read it again someday. ( )

READ IT ( )

Evocative and empathetic narrative medicine work that examines cross cultural barriers between the Hmong community and the Western medical community. A must-read.

Imagine becoming seriously ill in a foreign country, and having to deal with doctors who don't speak your language. Now, imagine that the doctors practice techniques that you find offensive and sometimes horrifying. And finally, imagine being treated as inferior by the doctors because of your beliefs. This is what happened to the Lee family, Hmong immigrants living in Merced, California. Foua and Nao Kao were forced to leave their homeland (Laos), and came to the United States as refugees. In 1982, Foua gave birth to a daughter, Lia, and early on it was determined she had a severe form of epilepsy. In this nonfiction book, Anne Fadiman chronicles the experiences of both Lia's family and those in the health and social services professions who provided care.

The cultural divide was huge. The Hmong believe in shamans and healing rituals, many involving animal sacrifice. Refrigerators, televisions, and even toilets were unfamiliar. Foua and Nao Kao were illiterate, and therefore unable to comprehend the complex and varying medicines prescribed for their daughter. The American doctors were well-educated, confident, and caring, but clearly considered themselves and their beliefs as superior to the Hmong. This chasm proved disastrous for Lia and her family.

Fadiman presents a very objective portrait, showing the good and bad sides of both the Americans and the Hmong involved. She dissects the case, ultimately identifying the point where a simple wrong turn set Lia on a course from which she could not recover. Fadiman weaves into the narrative educational segments on Hmong history, culture, and traditions. The result is a very informative and yet emotional story, that ultimately comes down to a collision of two cultures. As Harvard's Arthur Kleinman told Fadiman, "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" (p.261) ( )

http://amiralace.blogspot.com/2008/12... ( )

Anne Fadiman takes a very rare look into a fairly unknown culture, the Hmong. Tracing the people's unusual and exuberant independence back several centuries, examining attempts by the Chinese and the French to assimilate them, Fadiman is able to examine the Hmong's current plight in a modern, American society. Refugees, uprooted from everything that makes any sense to them, Hmong people face difficulties with the most simple things that American's daily take for granted - the use of a refrigerator or a phone, for instance. But the largest obstacle they face is in the clash of their cultural and religious beliefs with modern Amercian life.

Focusing on the Lees, a typical Hmong family, who migrated to Merced, CA, the book follows their long battle with Western medicine and doctors in treating their daughter, Lia, who is struck with epilepsy as an infant. Originally diagnosed with pneumonia, Lia begins a long spiral downward as her condition worsens and the doctors who treat her grow more and more intolerant of her parents care. Lia is even removed from her home and placed with foster parents based on a doctor's report that her parents have failed to adequately medicate her, even though the only family members who can read, write, or understand English are minors and the doctors only infrequently use the hospital janitor to interpret their instructions. To be fair, the doctors who treated Lia were well-meaning, caring, and earnest people. But their inability to connect with Lia's parents exposes a more disturbing and wider barrier between our Western focused systems and the ever growing immagrant population.

Fadiman is seldom judgemental of any of the players in the story, even when it would be easy to slip into such an attitude. The book is really an excellent examination of the clash of cultures in general and the Hmong people specifically. My primary criticism is that the book seemed too focused on garnering sympathy for the Lee's. They are an extraordinary family who suffered through a great many trials and mostly succeeded. However, I tend to agree with Fadiman's doctor firend whose opinion she exhibits in the closing chapters. He makes clear that, while respecting and using the Lee's cultural and religious perspectives might have helped serve the goal of treating Lia, the doctor's here were right to proceed with whatever means necessary to treat the girl in a way that saved her life. It would be silly to withhold or subjugate medical treatment in favor of Hmong holistic treatment simply to exhibit respect for the Lee's beliefs. Indeed, the doctors here failed in their duties to understand the Lee's and, in so doing, better understand their patient's condition. But, they could have overcome the gaps in understanding with an interpreter and a little more creative thinking about how to verify Lia's medicine was administered.

A good read, especially the portions of the book which highlighted the history of the Hmong people.

Four bones!!!! ( )

Supremely interesting, and, as another reviewer has said, it covers all the bases and provides an interesting glimpse into another culture. ( )

Bought through Amazon in July. Started 7/13/18. Finished 8/2/08.Wow, I liked this book alot more than I thought I was going to. It starts out great, but lags in the middle - I had to prode myself on a time or two. But the last 100 pages or so are terrific! They covered alot of history and it blew my mind! I think I'll hang onto this book. ( )

Fadiman writes about an uncomfortable subject in a sensitive and thought provoking way. She allowed me a glimpse into the lives of a people with whom I would otherwise have never come into contact. The failings of our well-intentioned, but grossly ineffective medical services are presented with care and sensitivity while not concealing or excusing them.

This book was not one I particularly wanted to read, but it was a selection of my local book club so I was a good sport and began to read. Within only a few pages wild horses couldn't have dragged me away from it. It is a story I'll carry with me for years to come. ( )

The Spirit Catches You and You Fall Down is the story of a Hmong child from Laos who has severe epilepsy, and her treatment in the American Medical system. It is a tragic story of miscommunication and cultural misunderstanding which leads to misdiagnosis and horrendous drugging of the child which eventually ends in her becoming a brain-dead vegetable.

The early chapters telling, as they do, the story of Lia’s illness, being removed from her parents and becoming a ward of the state and then being returned to her parents is heartbreaking and intensely absorbing.

When Fadiman inserts herself into the story, the interest breaks down and becomes repetitive and boring. When Fadiman gets back to the narrative and tells the story of Lia and her parents the story is immensely fascinating if emotionally disturbing. The parents were absolutely amazing in their love and care of this lovely but tragic child.

After chapter seven, she alternates between the personal story and factual analysis of the political and social aspects of the Hmong people. It became obvious that Fadiman’s strengths lie in the personal narrative, which could account for her success as an essayist. As an historian and social commentator she is less effective. Frankly, I found these chapters deadly dull and boring. Partly, because her skills in making these chapters interesting was lacking and partly because of the material which related to American/Hmong political matters which left me cold. The four stars are for the personal story. ( )

This is a fascinating and well-researched book about a clash of cultures that occurred when a young Hmong child named Lia was diagnosed with severe epilepsy. For me, the best thing about the book was Fadiman's ability to see the problem from all sides. She did an excellent job describing the same situation from both the viewpoint of Lia's highly capable and well-meaning yet somewhat culturally insensitive doctors and the viewpoint of her very committed but uneducated (by Western standards) parents. For anyone who is involved in medical care of recent immigrants, this book could be eye-opening. ( )

I discovered this book on LibraryThing and am so glad I did. There is so much that is interesting in this book - the story of Lia and the history of the Hmong in Asia, and the struggles of immigrant Hmong whose culture is so radically different from American culture. I'm an idealist, and a believer in an individual's right to themselves, so I found it difficult to believe that there could be such a struggle between two cultures - but it is in those struggles that understanding and change occur. While Lia's experience is immeasurably sad, I didn't find the search for ultimate cause very interesting. Things happen - there's no denying that Lia had a severe form of epilepsy that may have taken her life, even with optimal care. I find it amazing and inspiring that her family has continued to value her as an integral part of their family and have taken such painstaking care of her. I can only imagine the stress and burdens they shoulder every day. It is heartening to see that there are people who can be so selfless in their approach to the way they live their lives. I highly recommend this book to anyone who wants to know more about the Hmong, and on a more general level, wants to be challenged about cultural differences. ( )

We met to discuss Anne Fadiman's informative, eye-opening book. Fadiman gives readers a in-depth look at the clash of two cultures - the Hmong culture and the American medical system. It is difficult to explain the frustration we all felt reading about a Hmong child with epilepsy and the American doctors who tried to save her. Fadiman helps the reader understand the Hmong culture, their beliefs, the way they view life and how this is in direct opposition to American medical practices. ( )

I treasure the years I taught in Fresno, learning about the Hmong people -- their heritage and culture. Fadiman shares their stories with care. ( )

Excellent book. I appreciated the background history of the Hmong people. I picked up my copy of the book from a used bookstore for a quarter, after reading on the cover that Lia Lee suffered from epilepsy - a condition my daughter suffers from. My heart nearly broke after reading the book; for the family, the doctors, the caregivers, and mostly for Lia. Other reviews have covered the book more thoroughly, but I will say I believe Lia's parents truly, truly loved her. ( )

Lia Lee's parents never intended to come to the United States, but when the Vietnam War destroyed their village and left them refugees, they were forced to immigrate. Members of a reclusive mountain tribe called the Hmong, they adapted poorly to American culture and viewed official institutions with deep suspicion. Nonetheless, when their two-year-old daughter Lia began suffering massive seizures, they carried her to the emergency room of nearby Merced Hospital. That night began an epic clash of cultures that wounded every doctor and family member involved in the case. The Lees, deeply spiritual people, believed that physical illness is caused by a sickness of the soul. They hoped to combine Western medications with traditional Lao healing. In any case, with no knowledge of spoken or written English, they are unable to understand the complex series of medications perscribed by the doctors. Lia's physicians are equally hampered by labor-intensive jobs in a county hospital serving a low-income population. With no money for interpreters, they are overwhelmed by the onslaught of literally thousands of Hmong patients who seem not to value Western medicine. As Lia's seizures worsen, a legal controversy emerges: are her parents fit to be her caretakers?

Writer and former journalist Anne Fadiman chronicles each side of the story with great empathy and exhaustive detail. Chapters alternate between the story of Lia's illness and the history of the Hmong people, beginning with their folklore and continuing with their involvement in the Vietnam War and difficult assimilation to the United States. At first, these histories seem irrelevant, but by the end of the book, they allow us to see the Lees as a product of their own unique, valid culture -- just as much as the American doctors are a product of our own subjective American value system. Thanks to this meticulous research and outstanding objectivity, the book succeeds at one of literature's most difficut task: posing more questions rather than giving answers. I finished this book in just 3 days, but I know that I will spend many more pondering what makes a good parent or a good doctor and whether we can ever truly label one version of reality right and another wrong. ( )

I learned about the difference between Western medicine and Hmong medicine/spirituality. I think this is a very important book for anyone in the medical field, and actually for everyone because this country is full of different cultures and practices and we may not even know it. ( )

Excellent comparison of the clash between Hmong cultural views of epilepsy and the american medical establishment's view, centered on a hmong family's daughter living in California. ( )

I enjoyed reading this story about the Hmong and their relationship with the medical field. ( )

Drawn into the problems that occur when people do not understand one another, a child is lost, but continues to be loved. Everybody surrounding this child, Lia, invested a great deal in her, but it was not enough. This heart breaking story should help us all remain humble. Just because we believe we know something does not mean that we are doing what is best. ( )

The author captures the tension and frustration felt by both sides in this story: the Hmong immigrant family and the California doctors who try to help them. The book is organized as "fish soup," with a little history, a little culture, a little medical information, etc. It is not always linear, which makes it sometimes hard to follow. I especially found the portraits of the doctors to be harsh and unflattering, which some might say qualifies as "realism." I gained an appreciation for the Hmong people, their history, and their culture although they still seem unfathomable in some ways. ( )

Had to read this for a class on cultural competency in medicine. I found myself torn throughout the novel: I sympathized with the Hmong parents but empathized with the Western physicians treating the little girl.

The author does do a lot to address issues of cultural competence, but I believe she too often falls into the Western trap of praising the East at the expense of the West. The Hmong are treated more like noble savages than actual people; Fadiman considers any attack on the parents' irresponsibility concerning their daughter's medication a slight on the entire Hmong community rather than a very natural frustration at two people whose motives remain mysterious. For instance, Fadiman states that the Hmong revere epilepsy as a divine blessing -- so why do they keep bringing Lia in to the ER for treatment? Understanding that motivation would have been far more beneficial than any number of lectures on cultural competency.

Still, the book brought up a number of questions about patient autonomy (especially the role of parents in the medical care of minor children) and inter-cultural relationships. While a balanced portrayal would have been more satisfying, this is all we have for now. ( )