The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (FSG Classics)

WARNING: SPOILERS AHEAD, If you don't want to know how things turn out, don't read.--MSAs the title implies, this book offers an alternative perspective of epilepsy, or seizures, as seen through the lens of the Hmong people. It also provides a fresh view of Western so-called civilization itself, and most particularly Western medicine.I doubt there's any American today who doesn't harbor at least some ambivalence about how medicine's practiced in the United States, and I'm not just talking bills and insurance. Foua and Nao Kao Lee didn't trust the doctors who tended to their baby daughter Lia when she began to have seizures; they worried about doing damage to their baby's soul. In the Hmong culture, sickness is a signal of disturbance to the soul, and healing is a matter of tending to that soul. When did you last see an American doctor do that?Even had the doctors who cared for Lia known of this tenet of the Lees' belief system, they probably wouldn't have given it consideration. As things were, they knew little about their patient's family: not only did the Lees not understand English, but the Hmong culture is so far from that of anything remotely American, the doctors hadn't the ears to hear, eyes to see, or consciousness to absorb any of it. To them, as to many Americans, the Hmong are a "Stone Age" people, ignorant and superstitious.Certainly Hmong rituals and healing ceremonies are strange and arcane--but no stranger than those of the Catholic or Jewish faith: all utilize symbols, whether it's wine standing in for the blood of Jesus, drops of wine spilled onto a plate for Egyptian plagues, or a wooden bench transformed into a winged horse carrying a healer in search of a sick person's soul. Why is it that the good citizens of the United States laugh only at the latter?Writer Anne Fadiman decided to look at American medicine through the prism of Lia Lee's sad story. She discovered, and conveyed to readers, the richness of Hmong culture, devoid of sentimentality. Fadiman is careful not to imbue the Hmong with the kind of romanticism that European Americans tend to hold about Native Americans: she does not evade the fact that they can be extremely difficult. By allowing them full humanity, she brings them vividly to life the same way a novelist does her characters--though non-fiction, thi book is as compelling as a great novel.The Hmong came to America in the 1980s courtesy of war in Southeast Asia. They'd been living in the mountains of Laos, to which they'd migrated from China. The Hmong never assimilate into the culture of the country they inhabit, and have suffered persecution for centuries. Much like the Roma or the Jews, they're a migratory tribe without a homeland--but I doubt they ever felt quite as displaced as they did when they got to the United States. Because they helped the CIA in Laos, the Hmong were promised they'd be welcome in the U.S.--but when the troops left, they jetted only generals and hotshots out of the country, leaving the rest of the populace to fend for themselves. With the Laotian army hunting them down as enemies of the state, Hmong families set off on foot, carrying whatever they could manage. Many, particularly the old and the young, died along the way. Most possessions were shed, too heavy to carry, on the days-long journey. When they arrived in Thailand they were placed in refugee camps, where they waited to be rescued by the Americans. Those who were finally brought to America were `resettled' all over the map, without regard for family cohesion or transferability of survival skills: in Detroit, Minneapolis, Utah, Vermont--the Hmong were distributed all over the country so as to not unduly `burden' any one locality.The Hmong tend to have large broods of 12 or 13 children, who they deeply adore, and they view disability as a consequence of some parental transgression, for which they atone by treating children with disabilities extra lovingly. They're used to living near relatives, who they see frequently, if not daily. The diaspora of the Hmong represented unspeakable hardship--which they resolved with what they call their `second resettlement.'One family would pack up a hastily purchased jalopy and drive off, looking for a spit of land hospitable to growing vegetables and the herbs necessary for healing rituals. They'd end up where all pioneers do, in California, and send news to relatives in Detroit or Chicago or Billings, Montana. Eventually, pockets of Hmong were clustered in a few locations around the country. Of these, Merced, California, where the Lee family settled, is one of the largest.About one in every six residents of Merced, formerly an all-white rural area, is now Hmong. Here their culture and community thrived, parallel to the dominant culture, assimilating as little as possible. One way they did have to assimilate is medically: since 80% receive some form of government assistance, social services closely monitor them. American social workers do not have a high level of tolerance for cultural difference, and many Hmong practices, like gardening on the living room floor, or animal sacrifice, put parents in danger of losing their children to foster care--an unthinkable consequence that did occur, for a period of time, to Lia Lee.The Hmong had heard about Western medicine even before arriving on these shores. They approved of antibiotics--swallow a pill and get well in a week--but not of much else. Surgery was anathema, since cutting the flesh or removing organs risks the flight of the soul. When their daughter Lia fell into the hands of the medical establishment, the Lees suffered deep agony over every procedure, from IV insertion to spinal taps.Fadiman explores the interactions between the Lees and their daughter's medical caretakers in exhaustive detail. Whenever Lia suffers a setback, the Lees blame the doctors and their methods. The doctors accuse the Lees of "noncompliance" when they fail to properly dose Lia with three different kinds of anti-convulsants at the various times of day prescribed, not realizing that the Hmong don't even use clocks. Fadiman presents a balanced picture, blaming neither the family nor the hospital, but cultural barriers, for what goes wrong--and eventually things do go terribly wrong. By the age of four Lia is brain dead. The hospital hooks her up to feeding tubes, expecting her to die within days, but the Lees insist on taking her home, where they disconnect every tube and treat Lia as a favored family member. They take turns carrying her around on their backs; like a mama bird, Foua pre-chews her daughter's food and feeds it to her orally; they sacrifice pigs in healing ceremonies; and Lia sleeps with her parents every night. To the astonishment of the medical community, Lia does not die, and by the end of the book, years after being declared brain dead, she's still alive. As I write this, Lia Lee is still alive and lovingly cared for by her mother and siblings. Her medical condition has not changed. Her father, Nao Kao Lee, died in January of 2003.This book enriched, and possibly changed, my life. I can't recommend it too highly.

By the time more than two hundred people have reviewed a book and a hundred and seventy people have given it five stars, adding one's own two cents to the mix seems almost beside the point. Yet the significant minority who have written highly negative reviews seem to call out for response. Besides, I happened to love the book and want simply to share that fact.I knew nothing about the Hmong before reading this book and, from it, learned a lot about their history and traditional culture. I don't think there is any need to fear that readers of this book will imagine all Hmong to be like the ones Fadiman depicts, any more than, if I wrote a book about my Sicilian-immigrant great-grandparents (who probably had more in common with Fadiman's subjects than one might at first suspect) people would think it revealed much about Italian-Americans, or Italians in Italy, today.This book is "woven" out of two main strands: alternate chapters tell the story of the family whose daughter has major epilepsy, and alternate chapters describe the history and culture of the Hmong. Each strand is brilliantly done and as the book progresses each sheds light on the other.But there is a class of readers to whom I would recommend this book even if they have no interest in the Hmong, and that is anyone who cares about medicine in general and the state of health care in today's America in particular. I am an articulate, educated native speaker of English and I've had frustrating experiences. When I was seven I was in hospital with severe asthma. I was alone in the room when a nurse came in with what I now know was an intravenous bag, on its large metal rack, with tubes and needles dangling from it. I had never seen IV before and had no idea what this was. I asked the nurse; she said she was going to give me a blood test. She inserted the needle into my arm, wrapped a bandage around it, and walked out of the room. This terrified me: I knew very well that a blood test involves inserting a needle for about one minute. Why did the woman lie? Too busy? Too arrogant or stupid? I am fortunate today to have an excellent doctor but in the past I've had no shortage of this sort of "just obey and don't ask questions" attitude.Now imagine that I am a relatively uneducated American and I'm in a village in Laos with my child, who suddenly becomes gravely ill. I don't understand a word anyone is saying, but they're bringing my child some strange boiling liquid. Do I pull my child away, refusing to let other people do potentially harmful stuff to her? Or do I trust them because there's at least a chance that it might help her, and doing nothing is the greatest risk at all?But here is what Mrs. Fadiman's book shockingly reveals: the American doctors were sometimes more wrong than the girl's parents were. At least one of the medicines which her parents refused to give her really did turn out to be harmful to her. When the parents had custody of her and took care of her in their own way she flourished--who knows whether she would still be well now if they had been able to keep her?Mrs. Fadiman interviews the various doctors extensively. Most of them emerge as fiercely intelligent, thoughtful people who are examining their own mistakes. One of them points out the harmful assumptions behind a lot of the language used--"compliance", for example. It reduces the patient to a child, or the subject of a tyranny, from whom nothing is expected but obedience.Finally, this book asks us to ponder a difficult political problem. How much freedom should parents have over the raising of their own children? The parents in this book had their child taken away because they were not giving her the medicines prescribed by the doctors. Was this just? It seems to me that the government, in this case, did either too little or too much. If they had taken the child away for good, then perhaps, with consistent application of the prescribed medicines, she would have done well. If they had left her with the parents entirely, then she still might have done well (remember the parents are demonstrated to have been right more than once about their daughter's health on occasions when the doctors were wrong) and at least the parent-child bond would not have been violated as horribly as it in fact was. But the shuttling of the little girl back and forth between her parents and other families was inexcusable.All in all, a thought-provoking, balanced, and humane book, worth reading by anyone who cares about health, culture, family, folklore, and the human condition.And by the way, I despise political correctness and although I am living a genuinely "multi-cultural" life, most trendy talk about 'multi-culturalism' makes me run in the opposite direction. This book is a model of how to talk about the clash between two cultures in a way that is neither condescending (on either side) nor superficial or politically-loaded.

This book was so good. Like many said, it is very heavy on Hmong culture and history in between the parts about Lia, but I felt that that background was significant and helpful to understanding the family's experience and culture

I ordered this book for a class and found it very engaging. It is also well-constructed and withstood the abuse one would expect the possessions of a student to receive.

Aún no lo he terminado, pero me gusta mucho la historia y cómo escribe la autora.

I learned so much/gained an awareness about a people and culture and history that I had previously known nothing about. Anne Fadiman is and excellent writer as well. I will likely read this again.

Good

Brilliant and thought provoking. Everyone should read this book. All medical and nursing students should read it.t is especially of relevance to anyone working with people from a different cultural back ground whether in medicine, education or the workplace in general. However even those with similar backgrounds can be on different "wavelengths" and many misunderstandings arise because of this. If we are more open to other people's view of the world we can understand us and them more!

Well-written and intriguing the way the author weaves the family story with the recent history of the Hmong people and a description of their culture. I was very touched by the stubborn way they adher to their values and customs and especially by the depth and commitment of their love and. Ari g for each other. An important counter model to our own very individualistic society.