The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia's parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy. Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadiman's compassionate account of this cultural impasse is literary journalism at its finest. The current edition, published for the book's fifteenth anniversary, includes a new afterword by the author that provides updates on the major characters along with reflections on how they have changed Fadiman's life and attitudes.
Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty--and their nobility." --This text refers to an out of print or unavailable edition of this title.
From School Library Journal
YA?A compelling anthropological study. The Hmong people in America are mainly refugee families who supported the CIA militaristic efforts in Laos. They are a clannish group with a firmly established culture that combines issues of health care with a deep spirituality that may be deemed primitive by Western standards. In Merced, CA, which has a large Hmong community, Lia Lee was born, the 13th child in a family coping with their plunge into a modern and mechanized way of life. The child suffered an initial seizure at the age of three months. Her family attributed it to the slamming of the front door by an older sister. They felt the fright had caused the baby's soul to flee her body and become lost to a malignant spirit. The report of the family's attempts to cure Lia through shamanistic intervention and the home sacrifices of pigs and chickens is balanced by the intervention of the medical community that insisted upon the removal of the child from deeply loving parents with disastrous results. This compassionate and understanding account fairly represents the positions of all the parties involved. The suspense of the child's precarious health, the understanding characterization of the parents and doctors, and especially the insights into Hmong culture make this a very worthwhile read.?Frances Reiher, Fairfax County Public Library, VA
Copyright 1998 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.
From Library Journal
Award-winning reporter Fadiman has turned what began as a magazine assignment into a riveting, cross-cultural medicine classic in this anthropological exploration of the Hmong population in Merced County, California. Following the case of Lia (a Hmong child with a progressive and unpredictable form of epilepsy), Fadiman maps out the controversies raised by the collision between Western medicine and holistic healing traditions of Hmong immigrants. Unable to enter the Laotian forest to find herbs for Lia that will "fix her spirit," her family becomes resigned to the Merced County emergency system, which has little understanding of Hmong animist traditions. Fadiman reveals the rigidity and weaknesses of these two ethnographically separated cultures. In a shrinking world, this painstakingly researched account of cultural dislocation has a haunting lesson for every healthcare provider. Highly recommended for all collections.?Rebecca Cress-Ingebo, Fordham Health Sciences Lib., Wright State Univ., Dayton, Ohio
Copyright 1997 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.
From The New England Journal of Medicine
In The Spirit Catches You and You Fall Down, Anne Fadiman tells the story of a Hmong family's experience with the American health care system and highlights many of the weaknesses of what some describe as the best health care system in the world. Fadiman writes beautifully and weaves the story of the Lees, their doctors, and the social and political history of the Hmong people and their unwilling immigration to the United States into a book that is difficult to put down once started. The Spirit Catches You will appeal to anyone interested in the culture of medicine and the interface between different cultures. It will also attract readers interested in the dynamics of power in the doctor-patient relationship and readers who can find inspiration in one family's devotion to a chronically ill child.
Nao Kao and Foua Lee and their children came to the United States because they felt they had no other option. They could not return to their home in Laos because there they faced persecution, yet they had to leave their refugee camp in Thailand because it had been scheduled to close. They settled in a Hmong community in California, where their daughter Lia was born. The treatment of Lia's seizure disorder in the United States, both by her parents and by her health care providers, is the theme of this story. Fadiman takes the reader through the details of the treatment to paint a full picture of Lia's experience as a chronically ill Hmong child in America.
We learn, for example, that long before the Lees even considered coming to the United States they had heard rumors about American doctors: doctors casually take blood from people, including children (the Hmong believe that the body contains a finite amount of blood that is not replaceable); doctors remove organs from their patients to eat or sell for food; doctors anesthetize patients and in so doing put their patients' souls at large, leading to illness or death; and when Hmong are admitted to the hospital, doctors cut the "spirit-strings" from their wrists, thus disturbing their "life-souls." American doctors, in turn, often consider the Hmong to be ignorant, backward, and too reliant on animal sacrifices and other unacceptable practices. During Lia's treatment, the assumptions and beliefs that both parties brought to the patient-doctor interaction were never adequately explored. Doctors often took advantage of their powerful position, and along the way there was a lack of trust and respect between the family and the doctors. Much of Fadiman's book explores how each party blamed the other for the tragic outcome -- Lia's severe mental and physical disabilities.
In one of the book's final chapters, Fadiman suggests ways in which health care providers can improve their ability to care for patients whose background is different from their own. The chapter draws heavily on work by Arthur Kleinman and others who began exploring cross-cultural medicine before it became popular. Readers of Fadiman's book will understand, however, that to provide high-quality, appropriate care for the diverse populations using the U.S. health care system, health care providers and organizations must adequately assess the need for resources to address a wide range of cross-cultural issues. Holding a "diversity" or "multicultural" day in a hospital or medical school is a superficial and inadequate approach. More meaningful is participation by bilingual, bicultural, professionally trained interpreters, the lack of which played a major part in the miscommunication between the Lees and their physicians. Americans' lack of understanding of the hierarchy in the Hmong community and of how conflicts are resolved was also a major barrier that might have been addressed by a health worker representing the Hmong community. The Spirit Catches You illustrates how much time, energy, and commitment are necessary to understand another culture's perspective on health and wellness and to translate that understanding into the day-to-day practice of medicine.
Reviewed by JudyAnn Bigby, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.
From Kirkus Reviews
A vivid, deeply felt, and meticulously researched account of the disastrous encounter between two disparate cultures: Western medicine and Eastern spirituality, in this case, of Hmong immigrants from Laos. Fadiman, a columnist for Civilization and the new editor of the American Scholar, met the Lees, a Hmong refugee family in Merced, Calif., in 1988, when their daughter Lia was already seven years old and, in the eyes of her American doctors, brain dead. In the Lees' view, Lia's soul had fled her body and become lost. At age three months Lia had had her first epileptic seizure--as the Lees put it, ``the spirit catches you and you fall down.'' Lia's treatment was complex--her anticonvulsant prescriptions changed 23 times in four years--and the Lees were sure the medicines were bad for their daughter. Believing that the family's failure to comply with his instructions constituted child abuse, Lia's doctor had her placed in foster care. A few months after returning home, Lia was hospitalized with a massive seizure that effectively destroyed her brain. With death believed to be imminent, the Lees were permitted to take her home. Two years later, Fadiman found Lia being lovingly cared for by her parents. Still hoping to reunite her soul with her body, they arranged for a Hmong shaman to perform a healing ceremony featuring the sacrifice of a live pig in their apartment. Into this heart-wrenching story, Fadiman weaves an account of Hmong history from ancient times to the present, including their work for the CIA in Laos and their resettlement in the US, their culture, spiritual beliefs, ethics, and etiquette. While Fadiman is keenly aware of the frustrations of doctors striving to provide medical care to those with such a radically different worldview, she urges that physicians at least acknowledge their patients' realities. A brilliant study in cross-cultural medicine. -- Copyright ©1997, Kirkus Associates, LP. All rights reserved. --This text refers to an out of print or unavailable edition of this title.
“Superb, informal cultural anthropology--eye-opening, readable, utterly engaging.” ―Carole Horn, The Washington Post Book World
“This is a book that should be deeply disturbing to anyone who has given so much as a moment's thought to the state of American medicine. But it is much more . . . People are presented as [Fadiman] saw them, in their humility and their frailty--and their nobility.” ―Sherwin B. Nuland, The New Republic
“The Spirit Catches You and You Fall Down changed how doctors see themselves and how they see their patients. Anne Fadiman celebrates the complexity and the individuality of the human interactions that make up the practice of medicine while simultaneously pointing out directions for change and breaking readers' hearts with the tragedies of cultural displacement, medical limitations, and futile good intentions.” ―Perri Klass, M.D., author of A Not Entirely Benign Procedure
About the Author
About the Author
Anne Fadiman was born in New York City and raised in Connecticut and Los Angeles. After graduating from Harvard, she worked as a wilderness instructor in Wyoming before returning to New York to write. She has been a staff writer at Life, editor-at-large of Civilization, and editor of The American Scholar. Fadiman is also the author of two collections of personal essays, Ex Libris and At Large and At Small, as well as the editor of Rereadings and Best American Essays 2003. She is married to the writer George Howe Colt. Fadiman lives with her family in western Massachusetts and serves as the Francis Writer-in-Residence at Yale.