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The Spirit Catches You and You Fall Down by…
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The Spirit Catches You and You Fall Down (1997)

by Anne Fadiman

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3,571992,100 (4.23)265
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» See also 265 mentions

Showing 1-5 of 99 (next | show all)
Fantastic book about the clash between two cultures met in the arena of medicine. In 1980 Lia Lee was born in the United States, daughter of a Hmong refugee family from the remote mountains of Indochina. At three months old, she developed symptoms of epilepsy. Her parents viewed this condition as indication that her soul had been stolen by a malevolent spirit. Her team of doctors at the Merced Community Medical Center prescribed medicine that could halt her seizures and enable her to grow up to live a relatively normal life. But her parents did not understand the doctors' diagnosis, disagreed with their treatment, routinely failed to administer her medications and preferred to treat her with traditional Hmong healing methods. Both the doctors and her parents cared deeply for Lia, but their complete failure to understand each other led to a disastrous series of events and tragedy. This is a skillfully woven story built of Lia's complex medical case, her family's stubborn solidarity and an exploration into Hmong culture, history and folklore. The author has imbued it with patience and irony. It presents both sides of the story fairly, looking in equal depth at the doctors' concerns and the deep-rooted beliefs of the Hmong.

The final, precisely apt conclusion rings true:
"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?"

from the Dogear Diary ( )
  jeane | Jul 21, 2018 |
I find it extraordinary that this remarkable book sat on our bookshelf at home for several years without being read. It is without a doubt one of the finest pieces of nonfiction literature I could ever hope to read. On the surface, this is a sort of case study of the medical history of a small child belonging to a rather odd family, by American standards. Or so it seems. Are we interested in any "strange" family? More to the point, are we interested in a family that belongs to an ethnic group which seems a cross between the Amish in America and the Japanese soldiers who refused to surrender from their island hideouts after World War II. In actuality, this "investigation" takes us to a fascinating culture and its jarring juxtaposition to typical American life, an insight on American history and Southeast Asian foreign policy, a sociology master class, a comparative religious study, and, most emphatically, both broad and deep analysis of American health care. Certainly, the subject matter is a kind of "perfect storm" of aligned facts designed to intrigue us, but the author does stunning work in giving us views from every conceivable angle with both wide and narrow lenses. The author has published some books of essays since this book, but I crave the chance to read another full scale work like this one. ( )
1 vote larryerick | Apr 26, 2018 |
Audible version

Fairly certain I purchased this as a bargain audible book. Not remotely something I would normally listen to but really glad I did. There were parts I struggled to get through but I learned a great deal about a culture I was unfamiliar with.
Although written about a particular family about 20 years ago it is still timely because conflicts do still occur between medical people and people of different cultures. How scary to be a parent of a gravely ill young child and no one is able to adequately translate your language! No one understands your concerns about not only your child's physical well being but the well being of her soul. ( )
  bostonterrio | Nov 21, 2017 |
Deep respect for the tremendous amount of research that went into this book. Fadiman's clear journalistic style is also something I wished I'd encountered earlier, in a CNF writing class, to show that a engaging story can be created without a messy flaunting of the the "I". Her character is a quiet figure in the background, polite, terrified of offending, trying to conceal her sincere interest and eagerness about the case of the child Lia Lee. But through patience and a fortunate selection of go-betweens and translators/"cultural brokers" (it's all about who you know) the family opens up to her. I love the moment of girl bonding when she is gussied up in Hmong costume. Personal moments like these make up for the chapters of dry history that the book is interspersed with. But I found myself reading those anyway, because they didn't go on for too long that I lost interest. That's proof of skilled reportage right there, because my eyes usually glaze over at historical treatises.

However, a quick search will turn up a few reviews from the Hmong/Hmong-Americans, that point out a few inaccuracies in the information presented in the book, and other problems such as concepts that get misinterpreted during translation:

http://www.hmongnet.org/publications/spirit_review.html
http://hmongstudies.com/HSJ-v2n2_Yang.pdf

But this is inevitable, and we can't assume also that Hmong culture is the same all throughout. Maybe some things are true for Lia's family that aren't true for other Hmong families. So maybe it's not lack of fact-checking but simply that we can't generalize. Anyway, the Hmong reviewers' opinion is generally favorable. As another reviewer wrote here, Anne Fadiman's heart is in the right place. She does her best to present both sides fairly, even if, as she admits herself, she sometimes tends to romanticize the Hmong. But if some reviewers decry "Western bias!", so what? She is Western. She already did her darndest to look at things from the other side, and if any Western influences sneak in, it cannot be helped. It's always tough to write from an in-between state. It's almost like being a shaman herself, trying to cross the boundaries between two worlds. And to think I'd never heard of the Hmong people people, and now I do. So I think this awareness (I mean, beyond people in California and other parts of the USA, who might already be acquainted with them) is one of the triumphs of the book.

Again, I wish I'd read this sooner. New CNF idol.

PS. One remedy involved inserting a silver coin into a hardboiled egg and rolling it all over the body. That stood out for me because I heard about this from my Chinese friends! Although they said instead of turning black, the egg is supposed to be filled with little hairs that the egg is supposed to have sucked out of the body, that's why they call it the "fur/hair sickness" or something like that. I wonder if this is something the Hmong got from the Chinese, or the other way around. :) They also mention the ventusa (the vacuum therapy, or "cupping") and coin rubbing/scraping. My boyfriend makes me do the scraping thing (you get a sharp edge like a credit card, and rub the skin somewhere on the back, near the nape, until it's as red as a lobster) to him sometimes when his body is "overheated". ( )
  mrsrobin | Jun 24, 2017 |
Christ, what a ride. I thought this book would be dry and unreadable. I had to read this for my Cultures & Madness class and write a book report (that I still haven't done).

While there are times that it can be dense, it is very well written. Ms. Fadiman writes about the Hmong with incredible gravitas and emotionality. I don't know how she did it but, by the time I finished the book I was all teary. Sure, it could be that I haven't slept in days (finals) but I think it's because of how the story of this little Hmong girl touched me so deeply that it broke my heart to finish this book. It changed the way I see parenting, it changed the way I see the American medical system, it changed the way I see the Hmong whom I knew about thanks to Grey's Anatomy.

This book is not a happy book. It's actually sad, heartbreaking, morally complicated but manages to be uplifting at the same time. Again, I don't know how Ms. Fadiman does it. This book teaches us to be human and to keep empathy in the front of our minds and hearts whenever we encounter someone of a different culture. It's so easy to judge. It's so easy to hate. Empathy, kindness... those are the some of the tools that can change the world or at the very least, make it a little less worse.

I enjoyed this book immensely. ( )
1 vote lapiccolina | Jun 23, 2017 |
Showing 1-5 of 99 (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)
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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, 12 Mar 2015 18:06:27 -0400)

(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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