This book takes place in Merced, California and follows the plight of the Lee family, Hmong refugees from Houaysouy, Sainyabuli Province, Laos, who embark on a harrowing and at times disturbing medical journey after their daughter is diagnosed with epilepsy. Their experience with the American medical system, which at times feels like the type of battle to which you find out the Hmong people are accustomed, is only further marred by cultural misunderstanding. The Spirit Catches You… is an eye-opening presentation that forces you to be acutely aware of the pivotal role of culture as it relates to every aspect of life.
Fadiman sets out to demonstrate this cultural importance using as an example the Lee family and their experience with American medicine. When their daughter, Lia, was diagnosed with epilepsy they perhaps were more relaxed about the situation as Americans would be; in Hmong culture epileptics are seen as spiritually gifted and many of them end up becoming shamans. As such, the Lees only sought medical attention when worried because Lia’s seizures seemed stronger or longer lasting than others and once Lia was stabilized and home from the hospital the prescribed medicine regimen was loosely followed at best and disregarded at worst. In the meantime they consulted Hmong shamans and administered traditional medicines, believing them to be the most effective long-term treatment. Because doctors knew nothing of Hmong culture they could not accommodate the Lees’ in a way that would have better facilitated Lia’s health care and therefore found the Lees noncompliant; because the Lees knew very little about American culture, they did not feel comfortable following the doctors’ orders blindly as someone who was familiar with the US health care system would be apt to do. This miscommunication, illustrated Fadiman, led to many problems including but not limited to anger, frustration, and resentment by all parties involved, the delaying of medical treatment which doctors feel contributed to the stagnation of Lia’s health and regression of her mental capacity, the confiscation of Lia by the state to be placed in foster care, and ultimately her vegetative state. The battle culminates when, to the American doctors’ surprise, Lia is kept alive solely by her parents for years after they thought she would die.
To reinforce her assertion, Fadiman organizes her book in such a way that includes in every other chapter extensive history on the Hmong people from her own research using books, research journals, anthropology texts, and accounts from ethnography students and missionaries. By doing so, she ensures the reader is never confused for long as to why the Lees think and feel the way they do and therefore prevents any frustration the reader may experience stemming from ignorance. This information effectively explicates the link between culture and the philosophy of healthcare held by the Lees as you learn about the centuries of strife, battle, and death endured by the Hmong to avoid assimilation and preserve their cultural identity.
Fadiman set out to inform the mass public about cultural differences, their relevance, and the consequences of their nonobservance and she effectively made her point while creating an excellent narrative that is also a significant contribution to the field of anthropology. This book is thoroughly informative for its 352 pages and will appeal to any audience, as we all have something to learn about cultures other than our own.
Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Farrar, Straus and Giroux, 1997. 352 pages.