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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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3,6821032,111 (4.23)296

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English (102)  Piratical (1)  All languages (103)
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I may sound naive, but I will admit that I was shocked at just how ignorantly a bunch of educated doctors could treat a group of Asian immigrants to this country. In credible. And I am very glad to see that someone took the time to document this, as a very needed corrective not only for this particular group fo Laotian immigrants, but also on behalf of all of us who are misunderstood by the establishment, and even by members of our own 'In' groups themselves. ( )
  ShiraDest | Mar 6, 2019 |
This was an extremely sad book and it becomes even sadder when you realize that it's based on a real story. I had to read it for a nursing class, but it's defiantly the type of novel that I would read outside of class too. ( )
  AngelaRenea | Jan 12, 2019 |
"They wore strange clothes - often children's clothes, which were approximately the right size - acquired at the local Goodwill. When they undressed for an examination, the women were sometimes wearing Jockey shorts and the men were sometimes wearing bikini underpants with little pink butterflies. They wore amulets around their necks and cotton strings around their wrists (the sicker the patient, the more numerous the strings). They smelled of camphor, mentholatum, Tiger Balm, and herbs. When they were admitted to the hospital, they brought their own food and medicines. . . . Hmong patients made a lot of noise. Sometimes they wanted to slaughter live animals in the hospital. Tom Sult, a former MCMC resident, recalled, "They'd bang the crap out of some kind of musical instrument, and the American patients would complain. Finally we had to talk to them. No gongs. And no dead chickens."

This is such a well-written and extensively lived/researched book. What an impressive author Fadiman is. It's required reading now for incoming students at Yale School of Medicine (which certainly makes me think well of that school). Much of the book is about the Hmong and the western doctors taking away completely different understandings of their exchanges, and the doctors needing to better understand and respect the very different Hmong point of view. Fadiman explains how a large population of Hmong migrated from Laos (after supporting the U.S. in the war) to the small town of Merced, California, and gives a great depth of understanding to the spiritual and cultural underpinnings of their existence - they have survived oppression from the Chinese and others by stubbornly maintaining their identity and refusing to assimilate - they either fight or flee. That attitude, however, makes them unusual U.S. immigrants who have little interest in becoming part of the famed U.S. melting pot.

The title refers to a Hmong family's understanding of their little girl's epilepsy - a demon spirit caught her, and she fell down. But the severity of her symptoms cause them to take her to a nearby hospital, with very capable doctors. At that point, the misunderstandings begin, and her treatment suffers. The Lees attribute different motivations and meanings to what the doctors are saying, and the doctors do not sufficiently respect or have interest in traditional Hmong healing techniques or how the family views the situation. The failure to properly listen to the person(s) most concerned made me think of Being Mortal. Fadiman is scrupulously fair to both the Hmong and the medical professionals.

For those who have read the book already, this is an interesting article about it written 15 years after publication (those who haven't read it will want to avoid this article until they have): https://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by... ( )
2 vote jnwelch | Nov 17, 2018 |
“It is well known that involuntary migrants, no matter what pot they are thrown into, tend not to melt.”

In 1981, after relocating to Merced, California, Lia Lee was born to a Hmong refugee family, from Laos.. She quickly developed severe epilepsy. By 1988, she was living at home, brain-dead. The events that led up to this tragedy: the misunderstandings, the culture clashes and flawed decisions, are the backbone of this story. Of course, the book goes much deeper, as Fadiman becomes involved with this family, exploring all angles for some answers. This is a demanding and an emotional read, but the narrative flows with strength and confidence. It is a real eye-opener and a must read, especially for all medical students. ( )
1 vote msf59 | Nov 15, 2018 |
Done. Loved it. You should read it. ( )
  MeeshN_AZ | Oct 18, 2018 |
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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)
"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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