The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
“The Spirit Catches You and You Fall Down”* sounds like it’s describing someone getting into bed after a full day of tripping acid. In Hmong culture, it translates to “epilepsy”… *I was close*. For them, sickness is inextricably linked with the soul; thus they have txiv neebs, or shamans, who treat health issues by communicating with ethereal beings, namely dabs. A person could incur an illness if their soul wanders from the physical body for whatever reason. They could have an ADHD soul that is distracted by something shiny and floats away, the soul could be scared off by certain noises, the soul could grow weary of its surroundings and bail, etc. If only I could use that excuse at work and say that I must leave because my soul has decided it is bored of my environment. There are certain rituals that help retain the soul inside the body, but at the onset of sickness, the soul is the immediate culprit.
The particular case of epilepsy is complicated among Hmongs-- the seizures are indicative of the individual’s ability to communicate with a higher realm. As such, they don’t necessarily immediately scramble for an all-out cure. The notion of epilepsy as indicative of special powers is not purely Hmong; epileptics like my boy Dostoevsky, Lewis Carroll, and Vincent Van Gogh openly praised their disease for the surges of creativity that accompanied their seizures. The idea of illness having bits of “wellness” is supported by Oliver Sacks in The Man Who Mistook His Wife for a Hat. But epilepsy is also a severe neurological problem that can lead to some serious shit.
Eastern religion and culture is so mysterious and tantalizing to me, but sometimes Eastern-Western divisions seem insurmountable. For example, one time I dropped my phone and it was taken to an MTA employee from New Delhi. When I went to retrieve it, he refused to believe that it was mine because my phone background is a pic of my favorite Hindu god, Ganesha (I double-majored in Hinduism because I guess I was seeking unemployment?). We fought about it for quite some time until I finally convinced him that white people could dabble in India stuff too. As a token of goodwill and in order to encourage cultural exchange, I recommended the NSYNC Christmas album as representative of America.
The Lees—the family depicted in this book—have their world rocked as a result of Eastern-Western miscommunication much more detrimental than me not having my phone for twenty minutes. The parents, Foua and Ni Kao Lee, arrived in Merced, California as Laotian refugees in 1980. Foua birthed an epileptic child, Lia, in 1982. Lia was hospitalized numerous times and her doctors continued to note medical noncompliance from her parents. Over time, the relationship between the Lees and Lia’s physicians became frustrating as hell for both sides. Eventually, Lia had an uncontrollable epileptic attack that left her in a vegetative state for the rest of her life. At age four, she was pronounced brain dead. So, who is accountable for this tragedy? The book considers both sides.
The Hmong people have a negative perception of the American health system to begin with. At one point, a panel of Hmongs in Thailand sincerely asked if “American doctors eat the livers, kidneys, and brains of Hmong patients” (Fadiman, 32). Of course we do, when no one is looking and we have barbeque sauce handy! But truly, our practices stand in such stark contradiction to the belief system inherent in their medicinal approaches. For instance, they believe that the body has a finite amount of blood that it does not replenish; therefore, they are weary of blood draws and operations involving blood loss. They take issue with organ donation because it will interfere with their future reincarnation as a complete being. The list goes on.
I think it’s very easy to write off this line of thinking as naive or inept…but that’s also very rude. Fadiman consistently stresses that we are stubborn in our own perspective; we hail our point of view as correct above all else. It is the classic snare of ethnocentrism that keeps us from entertaining the possibility that “our view of reality is only a view, not reality itself" (Fadiman, 276).
On the other hand, the doctors at Merced Community Medical Center hit a brick wall any time they tried to effectively treat Lia. They had no understanding of the details behind Hmong reluctance to their method of care and extremely limited access to adequate translators. Even when they were able to properly communicate complicated dosage regimens to the illiterate, non-English-speaking Lees, they had no means of ensuring this was correctly adhered to at home. Surprise…it was not. Furthermore, it was virtually impossible to discern whether the Lees were defying their life-saving prescriptions out of stupidity, cultural misunderstanding, or outright parental neglect.
Ultimately, this all leads to some complicated stuff, which I won’t spoil for you.
Lia suffered as a result and I started to ask myself some hard-hitting questions. Should doctors give a patient suboptimal care and cater their therapeutic regimen such that the patient’s caregivers are more likely to comply? What constitutes discriminatory practice and how far should a doctor tailor his approach in light of the culture at hand? Where do parental rights and child rights start to clash, and when should the government get involved? What kind of reasonable culturally sensitive expectations can there be for doctors who already require so much schooling? How much stress can they be asked to endure when it comes to dealing with opposing cultures and subpar cross-cultural resources? How much assimilation should we mandate before it actually becomes a submergence of their culture completely? This is a book club GOLD MINE, you guys.
At the end of the day, there’s a bottom line: Lia is a vegetable. We’ll call her an asparagus because I really like asparaguses as of late. I found myself getting a little worked up at times when I wondered if I respect cultural values at the expense of life. My answer is a resounding: no. But there were better ways to handle this predicament, which Fadiman hopes to illuminate. Of course, hindsight is 20/20, but we can learn something after the fact.
Not only was Fadiman an absolute boss in carefully explaining Lia’s medical progression and giving a balanced account of the justifiable frustrations of both sides, but she also seamlessly integrated an elaborate lesson in Hmong history. We’ve all learned about the highly publicized Vietnam War, but I know no one, including myself, who has heard about the concurrent war in Laos pointedly dubbed the “Quiet War”. You learn about it in the book. lt involves the United States being assholes.
Also— welfare is a big thing in the book. The Lee’s situation is complicated by the fact that they could not afford to pay a single penny for the hundreds of hours of healthcare that was necessary for Lia. Not to mention Foua birthed seventeen children. Again, this book is a wellspring of discussion topics—power dynamics in the medical system, the cyclical nature of limitations for the poor, the structure of welfare programs, veteran aid, etc.
Overall, I was incredibly impressed with Fadiman’s presentation of such a heartbreaking event. She seems invested in the story—it took her eight years of research—but she also successfully surfaces all of the facts and the range of point of views. Everyone was trying to take care of Lia in the best way they knew how and I now feel that it’s unwise to categorically say that medical treatment trumps cultural beliefs. At the same time, I’m not one to wholeheartedly espouse cultural relativism. Moreover, this book taught me what it is to be human and understand others in their humanity. A Western “encounter with the Hmong is a confrontation with radical difference—in cosmology, worldview, ethos, texture of life…Unfortunately as [the French critic] Tzvetan Todorov reminds us, ‘The first, spontaneous reaction with regard to the stranger is to imagine him as inferior, since he is different from us’” (Fadiman, 167). Fadiman takes these weighty reminders and grounds them in a story that is both relatable and baffling. The book earns 5 out of 5 flames.
If you enjoyed this review, please consider purchasing this book from my Amazon Associates link: https://amzn.to/372LFdv. The commissions I receive from your purchase help pay for the costs of running this website. Thanks for your support!
