“A Little Medicine and a Little Neeb”: Culture and Communication in The Spirit Catches You and You Fall Down by Anne Fadiman

Anne Fadiman’s 1997 work, The Spirit Catches You and You Fall Down, is part medical case study, part historical reflection, and part cultural exploration. It recounts the tragic story of the Lees, a family of Hmong immigrants, and the medical professionals that were enlisted to treat the severe seizures by which their youngest daughter Lia is afflicted. Lia’s case of epilepsy is a drastic one, but the real conflict of the story lies in the Lees’ and the medical fields’ inability to make room for the other in what they believe to be the best course of action in treating Lia. To treat Lia, the doctors at Merced County Medical Center (MCMC) turn to medication. The Lee family, believing the cause of their daughter’s illness to be the result of soul-loss (what they call her neeb), appeal to the spirit world and its ability to cure their daughter. The tragedy occurs when neither one can begin to understand the needs of the other. The medical field, denying recognition of the Lees’ cultural response to Lia’s illness, causes feelings of resentment and distrust, which leads to the Lees’ ignoring the doctors’ instruction. This only makes Lia more ill, which further solidifies both sides’ feelings about the other’s treatment being incorrect.

Lia is caught in the middle of this cultural tug-of-war and suffers irrevocably because of it. Her seizures cause many complications. She eventually develops sepsis due to a missed bacterial infection likely contracted while she was at the hospital being treated for an extended seizure. Eventually, Lia enters an extreme vegetative state that neither medicine nor spiritual healing can cure. Lia’s case in The Spirit Catches You and You Fall Down is an extreme but important testament to the importance of recognizing the many differences that exist across cultures.

As Fadiman details in The Spirit Catches You, the Hmong are a people rich with culture. There are many instances throughout the work that exhibit the practices traditional to Hmong culture. Fadiman’s account of a typical birth is one example. To begin with when a pregnant Hmong woman goes into labor, she returns to her dirt-floor home from where she is likely working in the fields. The mother, in an effort to ensure that her child’s birth is not complicated, delivers in silence, which is only punctuated by quiet prayers to her ancestors. Once the baby is delivered, directly into the mother’s arms, the father cuts the umbilical cord and ties it with a string. The baby is then bathed in stream water, carried in a barrel made from bamboo, by the mother while she was still in labor. Some births require help from a local shaman, who can mediate between the family and the spirit world to ensure the child’s health. Sacred waters, chanting, and appeals to forgiveness can also be employed by family members on the unborn baby’s behalf (Fadiman, 1997, p. 4).

In any case, the treatment of the placenta once the child is born is of the utmost importance. A daughter’s is buried underneath the parents’ bed. A son’s is buried near a support pillar, symbolic of the male role in the family. Treating the placenta correctly is crucial, as each Hmong has a life-long connection to their own. Early ailments are often blamed on the state of the placenta underground (ants, for example, cause spots on the child). When the Hmong die, their soul reunites with the placenta, which is used as protection on the perilous journey toward rebirth. The Hmong believe that failure to take proper care of the placenta can lead to disastrous results. Lia was born in an American hospital. Her placenta was incinerated. The Lee family connects the start of their daughter’s troubles to this event (Fadiman, 1997, p. 5).

The Spirit Catches begins with a description of a typical Hmong birth and ends with an equally significant cultural event, the Hmong healing ceremony. To begin, the shaman, or txiv neeb, enters the home with his sacred tools: a saber, a gong, a rattle, and a set of finger bells. He also brings with him a ten-foot long board that attaches to supports in order to make a bench. This bench is representative of the flying horse that helped the first tvix neeb in his healing quests. According to the Hmong, however, it is not representative of the flying horse; it is the flying horse, just as, Fadiman explains, “to a devout Roman Catholic, the bread and the wine are not a symbol of Christ's body and blood but the real thing” (1997, p. 279). After all of the trials their family has endured, the Lees still hold sacred the teachings and beliefs of their culture.

The healing ceremony is a complex collection of rituals, chants, and sacrifice. During Lia’s healing ceremony, one small pig, whose soul is tied to the Lee family, is sacrificed. A larger pig, whose soul acts as proxy to Lia’s, is also sacrificed. The txiv neeb uses his finger bells to mark Lia with the pig’s blood, which guarantees her protection from evil spirits. Then, he calls to her soul, offering rice, egg, and chicken to it. Once these rituals are complete, he throws horns to the ground, and is able to divine whether or not Lia’s soul has heard his request. The ceremony ends with a feast that uses every part of the sacrificed pigs. Throughout the ceremony, the reverence the Hmong hold for the animals is remarkable. The animals die for the Lees, but the Lees are very grateful for it, paying it in “spirit money;” the txib neeb ensures that it will be well-rewarded at the end of the year. This ceremony reveals the connection the Lees still hold to their cultural and religious customs. Their respect for all living creatures is telling (Fadiman, 1997, pp. 282-9).

While The Spirit Catches You offers a collection of cultural events specific to the Hmong, the main thrust of the work is how the Hmong culture and American (more specifically, American medicine) culture interact with each other. Throughout the work the reader sees examples of perspective, racism, xenophobia, ethnocentrism, and differences between the collectivist and individualist cultures all playing a role in the conflicts that the Lee family and the medical professionals experience. Understanding these aspects of intercultural communication between the Lee family and the medical professionals assigned to help them makes clear exactly how Lia was less a victim of her disease and more one of the culture clash that existed to such a high degree around her.

To begin with, most of the conflicts that arise in The Spirit Catches You can be traced back to the cultural perspective of each party. Even the seriousness of Lia’s epilepsy is not entirely understood by the Lees, who, due to their own cultural background, view epileptics with a special reverence. In their native Hmong, individuals with Lia’s condition are said to have quag dab peg, translating to, “the spirit catches you and you fall down.” The individuals more often then not become shaman, because as Fadiman explains “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (1997, p. 21). With the language barrier and lack of perspective, it is difficult to explain to the doctors why the Lees are not more alarmed by their daughter’s condition. As Thomas G. Parish details in his “The Story Catches You and You Begin to Understand,” “This dichotomy creates an internal cultural tension, between the Lees' concern for the safety of their daughter and the belief that her seizures will provide her with a life of honor in the Hmong community” (2004, p. 132). Because the Lees do want their daughter’s illness cured, but do not necessarily view her seizures as a sign of that illness, they are less attentive to administering medication and following the doctor’s orders. The doctors label the Lees as non-compliant and become less sympathetic to their needs. This leads to an unfortunate situation where one party cannot understand the other and thus both are less receptive to each other’s needs. Sadly, it is Lia who suffers most.

Lack of perspective is not the only intercultural communication issue present. The Lee family moves to America with already solidified xenophobic ideas of the United States. Historical understanding is necessary to see exactly why this xenophobia exists, and Fadiman dedicates much of her work to providing it. According to Fadiman, the Hmong people’s first real contact with the United States occurred during the Viet Nam war, when they were enlisted to fight alongside the American troops. The Hmong have a history of resistance and rebellion, and they took readily to fighting. This history of being unaccepted, even in their own land, is a likely start of the general xenophobia that The Spirit Catches You portrays the Hmong as having throughout their history (Fadiman, 1997, pp. 119-20). Once the conflict in View Nam ended, the American presence left Laos, and the Hmong, who had been promised great reward, felt betrayed. Due to their involvement in the conflict, they were forced to flee their homeland, and many felt that they had no other choice but to emigrate from their home. Upon arrival in the United States, the Hmong immigrants realized that there were not resources to care for them. These events lead to a feeling of betrayal and distrust amongst the Hmong people. The Lee family is no exception, as they too, were forced out of Laos and into America (Fadiman, 1997, pp. 120-39). Even though the doctors at MCMC were not responsible for it, the Lees had been lied to by America before. They were not eager to have it happen again. The Lee family developed their xenophobia almost as a defense mechanism, but it had dire consequences in their lives.

While the Lees show xenophobia toward Americans in general, they also experience one more specifically related to American doctors. The Hmong people in the first wave of immigration to the United States had collected ideas of American medicine which had made there way to the Hmong. Fadiman recounts the story of Mao Thao who, after living in the United States for one year, returned to visit Ban Vinai, a refugee camp in Thailand. While there, she was asked various strange questions including: "Do American doctors eat the livers, kidneys, and brains of Hmong patients?” and “When Hmong people die in the United States, is it true that they are cut into pieces and put in tin cans and sold as food” (Fadiman, 1997, p. 32). These beliefs stem from a distinct difference in healing between Americans and the Hmong. Americans practice a much more internal medicine, healing from the inside out. The Hmong believe in healing the spirit, a practice that never necessitates cutting a person open. This erroneous information based in fact causing a distinct fear of the American people is an exemplary case of xenophobia. It also points to exactly why, in Lia’s worst stages of illness, her parents were reluctant to allow for the feeding tube, incubator, and various needles the doctors needed to attach to her. While for many people xenophobia is just an aspect they carry with them, for the Lees, it has very concrete consequences.

An additional aspect of intercultural communication represented in The Spirit Catches You occurs when examining the differences that arise between the Americans and the Hmongs as related to their opposing individualist and collectivist cultures. Americans are notoriously individualistic. The Hmong, on the other hand, place family and community above all else. Collectivism among the Hmong is explored by Fadiman as she chronicles the Hmong’s journey out of Laos into Thailand. To reach Thailand, where they could find refuge, was a month-long ordeal. Rather than each person trying their hardest to make their own way to safety, the Hmong people worked together, as “able-bodied adults usually took turns carrying the elderly, the sick, and the wounded until they were no longer able to do so” (Fadiman, 1997, p. 162). This collectivist attitude is commendable, but in a nation that is so well-known for individualism, it is often unrecognized as such.

Evidence of assimilation does present itself many times throughout The Spirit Catches You. The herbs Lia’s mother eats after she is born are grown in the parking lot outside of the Lees’ apartment (Fadiman, 1997, p. 9). At Lia’s birthday party, the family eats both a sacrificed chicken and, the quintessentially American, Doritos (Fadiman, 1997, p. 216). When the txiv neeb comes for Lia’s healing ceremony, he is wearing flip-flops and watches a Winnie-the-Pooh cartoon. Despite the Lees’ reluctance and distrust of American culture, a level of assimilation is inevitable, especially as their children grow up more and more Americanized. In fact, “role loss” is also discussed in the book. The Hmong people have always valued their eldest family members as sources of wisdom and advice. In America, however, the older people know less about the culture and workings of society, and so the young children begin to respect their elders less and less. Fadiman explains that this had a hand in Lia’s mother’s belief that she was stupid, and thus, would not be able to understand the doctors’ directions (1997, p. 206). This, in part, is the cause in Lia’s medical mishandling. Again, this cultural concept has a real-life implication for the Lee family.

Overall, The Spirit Catches You and You Fall Down is a textbook example of what happens when intercultural communication fails. At every turn, the Lee family and the medical field clash over issues that have little to do with their daughter’s illness directly. Instead, cultural perspective, xenophobia, and a clash of cultures in general lead to Lia’s poor treatment, and eventual loss of nearly all brain activity. That, with some cultural sensitivity and an attempt to understand the differences between the Hmong and the Americans, Lia Lee’s outcome could have been much more hopeful, is tragic.

References

Fadiman, A. (1997). The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux.

Parish, T. G. (2004). The Story Catches You and You Begin To Understand. Perspective on Physician Assistant Education, 15(2), 131-4. Retrieved April 9, 2014, from http://www.paeaonline.org/index.php?ht=action/GetDocumentAction/i/25426