Book Review: The Spirit Catches You and You Fall Down
Anne Fadiman’s nonfiction book is an anthropologist account of “the culture of the Hmong” and “the culture of American medicine”. The cultural collision between the two is documented by the detailing a Hmong child’s medical journey, Lia Lee, who is diagnosed with severe epilepsy by her American doctors and “the spirit that catches you and you fall down” by her parents. Lia’s parents, who are refugees from Laos who migrated to the United States in 1980, and her Merced County, California doctors had different views over how to care for Lia, which Fadiman argues resulted out of a “cross-cultural misunderstanding”, a commonality shared with many Hmong medical cases. Lia’s American doctors failed to address and comprehend Hmong culture, such as taboos, Hmong spiritual beliefs regarding medical treatments and the authority attributed to community leaders, and Lia Lee’s parents did not understand the American medical culture and practices, which in this case, prescribed a strict regimen of anti-convulsive medicines. Fadiman shows how the culture of Western medicine is “one-sided” in that doctors do not “acknowledge their patients’ realities”, such as their religious views. In Lia’s case, she suffered from a massive stroke and as a result, became brain dead, a tragedy which might have possibly been avoided if Lia’s physicians had a cross-cultural understanding and/or cultural broker to help comprehend why Lia’s parents failed to comply with her medicine regimen.
The structure of the narrative uses a fish-soup approach, which is a traditional Hmong structure of oral narratives reflecting the culture’s holistic view of the world: “the world is full of things that may not seem to be connected but actually are; that no event occurs in isolation” . Fadiman undertakes the ethnographic study from this holistic perspective by incorporating chapters that focus not only on Lia’s medical journey, but also, the history of the Hmong people, the historical context in which the migration of Hmong refugees came to America in the 1980s, the Hmong community’s resistance to the assimilation of American culture, Hmong culture, including traditions, oral narratives, spiritual beliefs and language. The author collected extensive amounts of primary and secondary sources of data, including interviews, Lia Lee’s case log, medical records, legal records, CPS file, and literature about Hmong culture and history.
Fadiman documents that the Hmong have a history of resisting assimilation, a reason why a fair share of them migrated from China to Indochina in the beginning of the nineteenth century. The history of the Hmong shows that the Hmong “would rather flee, fight or die than surrender” and “that they are rarely persuaded that the customs of other cultures, even those more powerful than their own, are superior”. The Hmong were deeply affected by the Vietnam war and were forced to migrate once again, with a large share choosing the United States to seek asylum. The Hmong were recruited to be a part of the CIA’s army in Laos during the Vietnam war and the Hmong fled out of danger once South Vietnam fell to Communist North Vietnam. The Hmong’s integration into American society was difficult for the adult Hmong refugees due to the language barrier and lack of transferrable job skills, such as farming skills, as many refugees were transferred to urban or suburban cities. There were large amounts of unemployment, something that conflicted with their drive for self-sufficiency, and high degrees of depression among the Hmong population. Whereas their children, especially the younger children, have been able to integrate more successfully.
The author notes that this book is about “communication and miscommunication across cultures”, which is evident in Lia’s story. It also demonstrates the problem with the American idea that immigrants must “Americanize” by assimilating into American culture, especially for a strong ethnic group, such as the Hmong people, and it highlights the ignorance and discrimination that the Hmong community encountered. Fadiman’s ethnography of Hmong culture is an insightful study, not only for cross-cultural medicine research, but also, for migration policy. The United States dispersed the Hmong population across the nation, mostly in urban and suburban cities, despite the fact that they came from agrarian communities and the Hmong have a strong ethnic community, which led to the eventual secondary migration to Merced, California. The state could have more successfully helped the Hmong refugees with their integration process.
Fadiman, Anne (2012), The Spirit Catches You and You Fall Down. A Hmong child, Her American Doctors, and the Collision of Two Cultures, Farrar, Straus and Giroux: New York.