Status
Available
Publication
Noonday (2007), 341 pages
Description
When three-month-old Lia Lee arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely proud people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication. Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.… (more)
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Media reviews
If tragedy is a conflict of two goods, if it entails the unfolding of deep human tendencies in a cultural context that makes the outcome seem inevitable, if it moves us more than melodrama, then this fine book recounts a poignant tragedy.
Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different.
User reviews
LibraryThing member brenzi
This book broke my heart. It made me angry. It enlightened me. I came out of the reading of it a different person. And it had me scratching my head, once again, at the inept handling of an immigrant issue by the United States government.
On the surface, the book is about the care that Lia Lee, an
First, a little bit about that history. The Hmong originally hailed from the mountains of China, but over centuries of being forced out of the lands they settled in they finally end up in Laos. In the 1960s and early 70s they fight on behalf of the U.S. against the Communist regime. In exchange for bearing arms for the Americans specifically as agents for the CIA:
”Every Hmong has a different version of what is commonly called ‘The promise’: a written or oral contract, made by CIA personnel in Laos, that if they fought for the Americans, the Americans would aid them if the Pathet Lao won the war. After risking their lives to rescue downed American pilots, seeing their villages flattened by incidental American bombs, and being forced to flee their country because they had supported the ‘American War,’ the Hmong expected a hero’s welcome here.” (Page 201)
Needless to say, they didn’t get what they expected. Instead here’s what happened: the U.S. government removed people from Laos who spoke no English and who were self-sufficient farmers from mountain regions. They plopped them into urban areas where they had no way to make a living therefore, forcing them to accept welfare. American neighbors immediately resented these immigrants for “eating welfare.”
Enter infant Lia Lee and her parents Foua and Nao Kao. As welfare recipients, they are entitled to Medicaid for Lia’s care at the hospital. The fact that they don’t speak English and the hospital doesn’t employ any qualified translators spells trouble. Throw in the fact that Lia’s case is very, very complicated and add to that a clash of cultures: western medicine versus Hmong customs and mores. The storm that ensues leads to a tragedy that is heartbreaking.
Fadiman’s narrative makes it easy to empathize with these parents and the plight of the Hmong. Even dedicated, well-meaning doctors cannot overcome severe communication problems and the daunting challenge of bridging the culture gap. Highly recommended.
On the surface, the book is about the care that Lia Lee, an
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infant Hmong immigrant in the early 1980s, who suffers from severe seizure disorder, received at a California hospital. But, more deeply, it investigates and reveals the long history of the proud Hmong people. And what Fadiman does so brilliantly is to make clear how that history affected the plight of one family.First, a little bit about that history. The Hmong originally hailed from the mountains of China, but over centuries of being forced out of the lands they settled in they finally end up in Laos. In the 1960s and early 70s they fight on behalf of the U.S. against the Communist regime. In exchange for bearing arms for the Americans specifically as agents for the CIA:
”Every Hmong has a different version of what is commonly called ‘The promise’: a written or oral contract, made by CIA personnel in Laos, that if they fought for the Americans, the Americans would aid them if the Pathet Lao won the war. After risking their lives to rescue downed American pilots, seeing their villages flattened by incidental American bombs, and being forced to flee their country because they had supported the ‘American War,’ the Hmong expected a hero’s welcome here.” (Page 201)
Needless to say, they didn’t get what they expected. Instead here’s what happened: the U.S. government removed people from Laos who spoke no English and who were self-sufficient farmers from mountain regions. They plopped them into urban areas where they had no way to make a living therefore, forcing them to accept welfare. American neighbors immediately resented these immigrants for “eating welfare.”
Enter infant Lia Lee and her parents Foua and Nao Kao. As welfare recipients, they are entitled to Medicaid for Lia’s care at the hospital. The fact that they don’t speak English and the hospital doesn’t employ any qualified translators spells trouble. Throw in the fact that Lia’s case is very, very complicated and add to that a clash of cultures: western medicine versus Hmong customs and mores. The storm that ensues leads to a tragedy that is heartbreaking.
Fadiman’s narrative makes it easy to empathize with these parents and the plight of the Hmong. Even dedicated, well-meaning doctors cannot overcome severe communication problems and the daunting challenge of bridging the culture gap. Highly recommended.
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LibraryThing member RidgewayGirl
The first, spontaneous reaction with regard to the stranger is to imagine him as inferior, since he is different from us.
The Spirit Catches You and You Fall Down by Anne Fadiman is the story of the infant daughter of Hmong refugees and how misunderstandings on both the side of the parents and of
The first half of this book was the amazing story of what happened. It's strength was that it was clear that from the beginning everyone wanted to do what was right. Her parents loved her and were excellent caregivers. Her doctors were dedicated and professional. Nevertheless, they spent much of the time in conflict, fatally separated by differences of beliefs and traditions. I appreciated Fadiman's telling of the story, which was both compassionate and impartial.
She lost that strength a little in the second half of the book, which detailed the history of the Hmong people and why they emigrated to the United States and why they didn't integrate in the way expected of them. In a nutshell, the US used the Hmong in their "quiet war" in Laos, bombing their villages and jungle environment into a wasteland, then leaving most of them to their fate when we pulled out of South East Asia. Many escaped across the Mekong river and settled in refugee camps in Thailand. The American government reluctantly allowing them to come to the US when Thailand shut the camps down. The Hmong didn't want to come, but there was truly nowhere else they could live. They believed that their wartime service had earned them a degree of thankfulness from the Americans, and we wondered why they were given welfare out of our tax dollars. It was a fascinating history, well-told, but in the telling she lost a little of the impartiality that had marked the first half. Maybe she had no choice; this wasn't a case of a story having two sides--we destroyed their way of life, while they fought valiantly on our side, but when the war was over we were resentful of our responsibility. And as Americans, we are often too attached to our melting pot view to allow immigrants to keep their way of life. I did agree with her views, I just felt a little preached to, which is never fun, even when you agree with the preacher.
The Spirit Catches You and You Fall Down by Anne Fadiman is the story of the infant daughter of Hmong refugees and how misunderstandings on both the side of the parents and of
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the American medical community led to tragedy. Lia Lee had severe, hard to control epilepsy. Her parents brought her to the hospital many times but were unable to communicate with the medical professionals caring for her due to both linguistic and cultural barriers. The result was that Lia did not receive the care she needed, and her family, as well as the Hmong community, were given ample reason to distrust American authorities.The first half of this book was the amazing story of what happened. It's strength was that it was clear that from the beginning everyone wanted to do what was right. Her parents loved her and were excellent caregivers. Her doctors were dedicated and professional. Nevertheless, they spent much of the time in conflict, fatally separated by differences of beliefs and traditions. I appreciated Fadiman's telling of the story, which was both compassionate and impartial.
She lost that strength a little in the second half of the book, which detailed the history of the Hmong people and why they emigrated to the United States and why they didn't integrate in the way expected of them. In a nutshell, the US used the Hmong in their "quiet war" in Laos, bombing their villages and jungle environment into a wasteland, then leaving most of them to their fate when we pulled out of South East Asia. Many escaped across the Mekong river and settled in refugee camps in Thailand. The American government reluctantly allowing them to come to the US when Thailand shut the camps down. The Hmong didn't want to come, but there was truly nowhere else they could live. They believed that their wartime service had earned them a degree of thankfulness from the Americans, and we wondered why they were given welfare out of our tax dollars. It was a fascinating history, well-told, but in the telling she lost a little of the impartiality that had marked the first half. Maybe she had no choice; this wasn't a case of a story having two sides--we destroyed their way of life, while they fought valiantly on our side, but when the war was over we were resentful of our responsibility. And as Americans, we are often too attached to our melting pot view to allow immigrants to keep their way of life. I did agree with her views, I just felt a little preached to, which is never fun, even when you agree with the preacher.
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LibraryThing member tymfos
This is an excellent account and analysis of the collision of two cultures. And it is a sad tale, indeed.
Lia is the child of Hmong refugees living in Merced, California. When she begins having seizures, her parents take her to the local hospital's emergency room. Soon Lia is a "regular," one of the
Lia's parents speak no English. They can't read a thermometer or the labels of her medications. They are also fearful of the medicine and what it might do to her spirit. Doctors treating Lia constantly break Hmong taboos and behave in ways that Lia's family misunderstand. It seems that no one tries to understand what Lia's family believes.
The resut, predictably, is a disaster.
Fadiman looks at the story from all points of view, trying to see what (if anything) might have changed the course of events toward a happier outcome. There are sympathetic people on both sides of the divide (though there a few real bigots, too).
She also looks at the broader issues of the Hmong experiences helping the CIA in the "Quiet War" in Laos and their plight when the Americans pulled out; their ordeal as refugees, and how their resettlement in America was mishandled.
Fadiman does a great job giving the reader the "big picture." And it is a story very much worth telling, and told in a compelling style.
Lia is the child of Hmong refugees living in Merced, California. When she begins having seizures, her parents take her to the local hospital's emergency room. Soon Lia is a "regular," one of the
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hospital's most challenging cases of chronic illess. The language barrier is difficult. The cultural barriers are even more daunting. The Hmong view illness in spiritual terms. Modern American medicine has a very different approach. Neither side understands what the other is thinking or feeling or where they are coming from.Lia's parents speak no English. They can't read a thermometer or the labels of her medications. They are also fearful of the medicine and what it might do to her spirit. Doctors treating Lia constantly break Hmong taboos and behave in ways that Lia's family misunderstand. It seems that no one tries to understand what Lia's family believes.
The resut, predictably, is a disaster.
Fadiman looks at the story from all points of view, trying to see what (if anything) might have changed the course of events toward a happier outcome. There are sympathetic people on both sides of the divide (though there a few real bigots, too).
She also looks at the broader issues of the Hmong experiences helping the CIA in the "Quiet War" in Laos and their plight when the Americans pulled out; their ordeal as refugees, and how their resettlement in America was mishandled.
Fadiman does a great job giving the reader the "big picture." And it is a story very much worth telling, and told in a compelling style.
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LibraryThing member labfs39
I loved everything about this book: the story of Lia Lee, the description of the medical dilemma facing the doctors, the theorizing about cultural clashes, the history of the Hmong. Anne Fadiman writes clearly and compellingly about a complex case, and it reads like fiction. I was fascinated by the
As the author says, to tell a Hmong story, you need to go back to one of the many beginnings. I'll start with the war the CIA fomented and funded in Laos against the communists. I wasn't aware that the soldiers in this "quiet war" were Hmong, and that when the CIA tired of the game and pulled out, they left behind tens of thousands of targeted Hmong. The Lees were one of the families that emigrated to the US after a harrowing flight, ending up in Merced, California.
Lia was their youngest child, and particularly beloved, in part perhaps because she was the youngest and they had lost some of their older children to starvation and other horrors of war. But Lia was also loved because she was special. She was subjected to qaug dab peg, the spirit catches you and you fall down, or what Western doctors call epilepsy. This condition marked Lia, perhaps even destined her to become a shaman to her people. When her seizures were bad, Lia's parents took her to the clinic to receive medicine to help her in the moment, but not to cure her.
Lia's doctors, on the other hand, saw the epilepsy as a serious disease needing a drastic cure. Complicated schedules of stronger and stronger medicines were devised, spinal fluid was analyzed, veins were cut when IV's could no longer be inserted in the normal fashion. As her treatment became more complex and invasive, Lia's parents became more and more resistant. Often being without a translator, doctors and parents talked at each other with no comprehension on either side of the cultural barrier. And in the meantime, Lia gets worse.
The author does a wonderful job of portraying the doctors as caring, intelligent, dedicated people frazzled by overwork and what they see as noncompliance; and the Lees as caring, devoted parents doing their best to find a compromise between this confusing world and the known world they left behind. Since the book was published fifteen years ago, cultural differences are more acknowledged now, I think, even if the bridges between cultures are still far and few between. For this reason, the book is as relevant today as when it was written. Highly recommended.
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glimpses of Hmong life both in Laos and in the US, of the Hmong language, and of Hmong music and how it can imitate speech. But most importantly, the book is well researched and balanced, showing how both doctors and parents were trying to do their best by the child.As the author says, to tell a Hmong story, you need to go back to one of the many beginnings. I'll start with the war the CIA fomented and funded in Laos against the communists. I wasn't aware that the soldiers in this "quiet war" were Hmong, and that when the CIA tired of the game and pulled out, they left behind tens of thousands of targeted Hmong. The Lees were one of the families that emigrated to the US after a harrowing flight, ending up in Merced, California.
Lia was their youngest child, and particularly beloved, in part perhaps because she was the youngest and they had lost some of their older children to starvation and other horrors of war. But Lia was also loved because she was special. She was subjected to qaug dab peg, the spirit catches you and you fall down, or what Western doctors call epilepsy. This condition marked Lia, perhaps even destined her to become a shaman to her people. When her seizures were bad, Lia's parents took her to the clinic to receive medicine to help her in the moment, but not to cure her.
Lia's doctors, on the other hand, saw the epilepsy as a serious disease needing a drastic cure. Complicated schedules of stronger and stronger medicines were devised, spinal fluid was analyzed, veins were cut when IV's could no longer be inserted in the normal fashion. As her treatment became more complex and invasive, Lia's parents became more and more resistant. Often being without a translator, doctors and parents talked at each other with no comprehension on either side of the cultural barrier. And in the meantime, Lia gets worse.
The author does a wonderful job of portraying the doctors as caring, intelligent, dedicated people frazzled by overwork and what they see as noncompliance; and the Lees as caring, devoted parents doing their best to find a compromise between this confusing world and the known world they left behind. Since the book was published fifteen years ago, cultural differences are more acknowledged now, I think, even if the bridges between cultures are still far and few between. For this reason, the book is as relevant today as when it was written. Highly recommended.
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LibraryThing member writer1985
Had to read this for a class on cultural competency in medicine. I found myself torn throughout the novel: I sympathized with the Hmong parents but empathized with the Western physicians treating the little girl.
The author does do a lot to address issues of cultural competence, but I believe she
Still, the book brought up a number of questions about patient autonomy (especially the role of parents in the medical care of minor children) and inter-cultural relationships. While a balanced portrayal would have been more satisfying, this is all we have for now.
The author does do a lot to address issues of cultural competence, but I believe she
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too often falls into the Western trap of praising the East at the expense of the West. The Hmong are treated more like noble savages than actual people; Fadiman considers any attack on the parents' irresponsibility concerning their daughter's medication a slight on the entire Hmong community rather than a very natural frustration at two people whose motives remain mysterious. For instance, Fadiman states that the Hmong revere epilepsy as a divine blessing -- so why do they keep bringing Lia in to the ER for treatment? Understanding that motivation would have been far more beneficial than any number of lectures on cultural competency.Still, the book brought up a number of questions about patient autonomy (especially the role of parents in the medical care of minor children) and inter-cultural relationships. While a balanced portrayal would have been more satisfying, this is all we have for now.
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LibraryThing member Lisa2013
recommended for: anyone who has interest in understanding people different from them
I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I
Anne Fadiman does a remarkable job of communicating both sides of this story; it’s probably one of the best examples of cross-cultural understanding that I’ve ever read. It’s ostensibly about a young Hmong girl with epilepsy and her family’s conflict with the American medical establishment, and there is much about them here.
But it’s also a wonderful history book. There’s much background about the Hmong people going back centuries and recent history also. It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland.
I learned so much about the Hmong people; I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context. And, as I was reading, I was really struck by how cultural differences (and the cultural differences between the Hmong and American cultures is about as far apart as it gets) can completely hinder communication if they’re not acknowledged and attempts are made to bridge the gap. This is a great book to read if you want to try to understand any people who are different from you in any way.
Beautifully written and an enjoyable read.
I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I
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have my issues with the western medical establishment as well. Not that I didn’t feel angry (and amused) at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman’s account of the events. My culture is definitely that of an American (well, a subculture anyway, as there are obviously many cultures within America!) and I am fairly wedded to it, but I really appreciated this look into a culture so different from my own.Anne Fadiman does a remarkable job of communicating both sides of this story; it’s probably one of the best examples of cross-cultural understanding that I’ve ever read. It’s ostensibly about a young Hmong girl with epilepsy and her family’s conflict with the American medical establishment, and there is much about them here.
But it’s also a wonderful history book. There’s much background about the Hmong people going back centuries and recent history also. It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland.
I learned so much about the Hmong people; I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context. And, as I was reading, I was really struck by how cultural differences (and the cultural differences between the Hmong and American cultures is about as far apart as it gets) can completely hinder communication if they’re not acknowledged and attempts are made to bridge the gap. This is a great book to read if you want to try to understand any people who are different from you in any way.
Beautifully written and an enjoyable read.
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LibraryThing member lauralkeet
Imagine becoming seriously ill in a foreign country, and having to deal with doctors who don't speak your language. Now, imagine that the doctors practice techniques that you find offensive and sometimes horrifying. And finally, imagine being treated as inferior by the doctors because of your
The cultural divide was huge. The Hmong believe in shamans and healing rituals, many involving animal sacrifice. Refrigerators, televisions, and even toilets were unfamiliar. Foua and Nao Kao were illiterate, and therefore unable to comprehend the complex and varying medicines prescribed for their daughter. The American doctors were well-educated, confident, and caring, but clearly considered themselves and their beliefs as superior to the Hmong. This chasm proved disastrous for Lia and her family.
Fadiman presents a very objective portrait, showing the good and bad sides of both the Americans and the Hmong involved. She dissects the case, ultimately identifying the point where a simple wrong turn set Lia on a course from which she could not recover. Fadiman weaves into the narrative educational segments on Hmong history, culture, and traditions. The result is a very informative and yet emotional story, that ultimately comes down to a collision of two cultures. As Harvard's Arthur Kleinman told Fadiman, "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" (p.261)
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beliefs. This is what happened to the Lee family, Hmong immigrants living in Merced, California. Foua and Nao Kao were forced to leave their homeland (Laos), and came to the United States as refugees. In 1982, Foua gave birth to a daughter, Lia, and early on it was determined she had a severe form of epilepsy. In this nonfiction book, Anne Fadiman chronicles the experiences of both Lia's family and those in the health and social services professions who provided care. The cultural divide was huge. The Hmong believe in shamans and healing rituals, many involving animal sacrifice. Refrigerators, televisions, and even toilets were unfamiliar. Foua and Nao Kao were illiterate, and therefore unable to comprehend the complex and varying medicines prescribed for their daughter. The American doctors were well-educated, confident, and caring, but clearly considered themselves and their beliefs as superior to the Hmong. This chasm proved disastrous for Lia and her family.
Fadiman presents a very objective portrait, showing the good and bad sides of both the Americans and the Hmong involved. She dissects the case, ultimately identifying the point where a simple wrong turn set Lia on a course from which she could not recover. Fadiman weaves into the narrative educational segments on Hmong history, culture, and traditions. The result is a very informative and yet emotional story, that ultimately comes down to a collision of two cultures. As Harvard's Arthur Kleinman told Fadiman, "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" (p.261)
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LibraryThing member SheTreadsSoftly
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman is a balanced account of the clash between a Hmong family and Western medicine. Fadiman follows how the medical community handled or mishandled the case of Lia Lee, and
The Lees immigrated to Merced, California, from Laos in 1980. At three months old, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, "the spirit catches you and you fall down." The problem was that, to put it simply, the medical community and the family were unable to understand each other.
The problems went beyond a simple language barrier. In addition to the language barrier, there was no understanding of religious or social customs. It was a complete cross-cultural failure on all levels.
Lia's anti-convulsant prescriptions changed 23 times in four years, which would put a strain on any family. And just like, in my opinion, any family, the Lees were sure the medicines were bad for their daughter. The difference is that most American families could question their doctors and make their feelings known. The Lee's were unable to communicate their displeasure with the medication. Even when the medical community wrote down prescriptions or amounts for the Lees, they had no idea that the Lees could make no sense of the numbers and letters. Additionally, the Lees would have liked to address the spiritual connections they felt were essential for Lia's healing.
Lia's doctor, rather than finding a way to work with the Lees and make sure Lia received her medication, reported them for "noncompliance" and child abuse. Lia was placed in a foster home. Lia's parents and her doctors both wanted what was best for Lia, but the misunderstandings between them led to tragedy. When Lia's death was 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, who were still hoping to reunite her soul with her body.
Winner of the National Book Critics Circle Award for Nonfiction, my edition of The Spirit Catches You and You Fall Down includes: a preface; notes on Hmong orthography, pronunciation, and quotations; notes on sources; chapter notes; a bibliography; acknowledgments; an index; and a reader's guide.
I have had The Spirit Catches You and You Fall Down sitting on my shelf, waiting to be read for four years. Shame on me. This is a beautifully crafted, careful study in cross cultural medicine. While it would be very easy to take a "side", Fadiman is extremely even handed. She presents the facts, acknowledges short comings on both sides, and somehow tells the whole tragic story without any condemnation. This should be a must read for anyone in the medical field.
Very Highly Recommended - one of the best
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her parents Nao Kao and Foua, a Hmong family. She also follows the history of the Hmong.The Lees immigrated to Merced, California, from Laos in 1980. At three months old, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, "the spirit catches you and you fall down." The problem was that, to put it simply, the medical community and the family were unable to understand each other.
The problems went beyond a simple language barrier. In addition to the language barrier, there was no understanding of religious or social customs. It was a complete cross-cultural failure on all levels.
Lia's anti-convulsant prescriptions changed 23 times in four years, which would put a strain on any family. And just like, in my opinion, any family, the Lees were sure the medicines were bad for their daughter. The difference is that most American families could question their doctors and make their feelings known. The Lee's were unable to communicate their displeasure with the medication. Even when the medical community wrote down prescriptions or amounts for the Lees, they had no idea that the Lees could make no sense of the numbers and letters. Additionally, the Lees would have liked to address the spiritual connections they felt were essential for Lia's healing.
Lia's doctor, rather than finding a way to work with the Lees and make sure Lia received her medication, reported them for "noncompliance" and child abuse. Lia was placed in a foster home. Lia's parents and her doctors both wanted what was best for Lia, but the misunderstandings between them led to tragedy. When Lia's death was 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, who were still hoping to reunite her soul with her body.
Winner of the National Book Critics Circle Award for Nonfiction, my edition of The Spirit Catches You and You Fall Down includes: a preface; notes on Hmong orthography, pronunciation, and quotations; notes on sources; chapter notes; a bibliography; acknowledgments; an index; and a reader's guide.
I have had The Spirit Catches You and You Fall Down sitting on my shelf, waiting to be read for four years. Shame on me. This is a beautifully crafted, careful study in cross cultural medicine. While it would be very easy to take a "side", Fadiman is extremely even handed. She presents the facts, acknowledges short comings on both sides, and somehow tells the whole tragic story without any condemnation. This should be a must read for anyone in the medical field.
Very Highly Recommended - one of the best
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LibraryThing member larryerick
I find it extraordinary that this remarkable book sat on our bookshelf at home for several years without being read. It is without a doubt one of the finest pieces of nonfiction literature I could ever hope to read. On the surface, this is a sort of case study of the medical history of a small
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child belonging to a rather odd family, by American standards. Or so it seems. Are we interested in any "strange" family? More to the point, are we interested in a family that belongs to an ethnic group which seems a cross between the Amish in America and the Japanese soldiers who refused to surrender from their island hideouts after World War II. In actuality, this "investigation" takes us to a fascinating culture and its jarring juxtaposition to typical American life, an insight on American history and Southeast Asian foreign policy, a sociology master class, a comparative religious study, and, most emphatically, both broad and deep analysis of American health care. Certainly, the subject matter is a kind of "perfect storm" of aligned facts designed to intrigue us, but the author does stunning work in giving us views from every conceivable angle with both wide and narrow lenses. The author has published some books of essays since this book, but I crave the chance to read another full scale work like this one. Show Less
LibraryThing member Grogotte
If I ever write non-fiction, I want to write like Fadiman. I have found her The Spirit Catches You and You Fall Down to be one of the best-written works of socio/anthropology for a broader audience I have read in a long time. There are many good books in this category, but few of them have weaved
I wish more people around me read this book, not only because it is interesting in and of itself, but because Fadiman demonstrates how every human story has many sides, and things are always more complicated than they seem.
A powerful and important book for me.
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together this caliber of scholarly thinking, journalistic coverage, and humanity in a single book that remains, on the whole, rather accessible. I wish more people around me read this book, not only because it is interesting in and of itself, but because Fadiman demonstrates how every human story has many sides, and things are always more complicated than they seem.
A powerful and important book for me.
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LibraryThing member solla
There was a point during the read that I felt that the two cultures of Hmong and medical American were just too far apart ever to reach any understanding of the other's true intentions. But, of course, that isn't so, and there are moments even in this book when some of the barriers break down. The
The book describes how this conflict plays out, and, very well, so that you understand that both sides agonized over what was going on. Mixed in there are short descriptions of Hmong history in China and Southeast Asia, and about their role with the U.S. during the Vietnam war era.
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story in brief is what happens when a Hmong family brings their dearly loved child, a toddler, to a hospital when she begins to have epileptic seizures. The seizures are very serious. First, without translators, it is not until the third visit that the doctors really know what is happening, when they are actually able to see a seizure happening. Then the medicines are continually adjusted, have complicated dosages, and lots of side effects. Though they've sought the doctor, the parents come to believe that their daughter is suffering from too much medicine, and they resist giving the ones that they perceive as causing the most damage. In addition getting the doses correct is difficult for them, as they are illiterate. They perceive illness as losing contact with your soul, and epilepsy, besides being an illness, has a spiritual dimension which can mean that a person can fill a role similar to a shaman. The doctors, on the other hand, see them as doing harm to their daughter by not following their medical instructions exactly.The book describes how this conflict plays out, and, very well, so that you understand that both sides agonized over what was going on. Mixed in there are short descriptions of Hmong history in China and Southeast Asia, and about their role with the U.S. during the Vietnam war era.
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LibraryThing member IAmChrysanthemum
The most important and difficult moment of this book:
"That's tyranny," said Sukey. "What if you have a family who rejects surgery because they believe an illness has a spiritual cause? What if they see a definite possibility of eternal damnation for their child if she dies from surgery? Next to
"I make no apology," said Bill [the biomedically trained doctor]. "The life comes first."
"The soul," said Sukey.
I love how the author takes no sides. What happens to little Lia, and her Hmong family and her American doctors desperately trying to help her, is tragic. But both biomedicine and traditional medicine have their faults. To achieve optimal health outcomes, it's up to both groups to resolve these problems and reconcile.
"That's tyranny," said Sukey. "What if you have a family who rejects surgery because they believe an illness has a spiritual cause? What if they see a definite possibility of eternal damnation for their child if she dies from surgery? Next to
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that, death might not seem so important. Which is more important, the life or the soul?""I make no apology," said Bill [the biomedically trained doctor]. "The life comes first."
"The soul," said Sukey.
I love how the author takes no sides. What happens to little Lia, and her Hmong family and her American doctors desperately trying to help her, is tragic. But both biomedicine and traditional medicine have their faults. To achieve optimal health outcomes, it's up to both groups to resolve these problems and reconcile.
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LibraryThing member winecat
I cannot recommend this book enough. From the first page you are drawn into the real life culture clash of the Hmong people and the American doctors that are trying to help a tiny child.
It makes you think about how doctors are trained, how bringing refugees into our country and providing them with
A fascinating tale that in turn breaks your heart for Lia, the Hmong child, her parents and her American doctors.
All of them are trying to do their best for Lia put miscommunication, misinterpretation and misunderstanding abound.
Should be read by every medical student as a cautionary tale.
It makes you think about how doctors are trained, how bringing refugees into our country and providing them with
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little or no support comes together. The Hmong are a VERY tight community with little interaction with the people of their own country let alone ours.A fascinating tale that in turn breaks your heart for Lia, the Hmong child, her parents and her American doctors.
All of them are trying to do their best for Lia put miscommunication, misinterpretation and misunderstanding abound.
Should be read by every medical student as a cautionary tale.
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LibraryThing member pgchuis
I found parts of this book fascinating and all of it well-written, but (while I appreciate that it was relevant in explaining the Hmong attitude to the US) the chapter on the war in Laos was not so interesting to me. There were also large sections dealing with general Hmong experiences and
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anecdotes about lack of assimilation which I found a distraction from the main story. The writer did make me sympathize with Lia's parents to an extent, but I struggled throughout with an inability to understand their resistance to learning English. I struggled also (and I think this was part of the point) to work out whether, when an interpreter was present, the interpreter interpreted badly or the Lees only pretended to understand or the Lees understood but decided to disregard what was being said or what?? There were times when this was about something very simple. Also, if the Lees rejected Western medicine, why did they keep taking Lia to the hospital. (I appreciate that my Western bias is coming out here...) Show Less
LibraryThing member msf59
“It is well known that involuntary migrants, no matter what pot they are thrown into, tend not to melt.”
In 1981, after relocating to Merced, California, Lia Lee was born to a Hmong refugee family, from Laos.. She quickly developed severe epilepsy. By 1988, she was living at home, brain-dead.
In 1981, after relocating to Merced, California, Lia Lee was born to a Hmong refugee family, from Laos.. She quickly developed severe epilepsy. By 1988, she was living at home, brain-dead.
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The events that led up to this tragedy: the misunderstandings, the culture clashes and flawed decisions, are the backbone of this story. Of course, the book goes much deeper, as Fadiman becomes involved with this family, exploring all angles for some answers. This is a demanding and an emotional read, but the narrative flows with strength and confidence. It is a real eye-opener and a must read, especially for all medical students. Show Less
LibraryThing member 7DogNight
Fadiman writes about an uncomfortable subject in a sensitive and thought provoking way. She allowed me a glimpse into the lives of a people with whom I would otherwise have never come into contact. The failings of our well-intentioned, but grossly ineffective medical services are presented with
This book was not one I particularly wanted to read, but it was a selection of my local book club so I was a good sport and began to read. Within only a few pages wild horses couldn't have dragged me away from it. It is a story I'll carry with me for years to come.
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care and sensitivity while not concealing or excusing them. This book was not one I particularly wanted to read, but it was a selection of my local book club so I was a good sport and began to read. Within only a few pages wild horses couldn't have dragged me away from it. It is a story I'll carry with me for years to come.
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LibraryThing member Hebephrene
Superb. It is listed some places as a memoir which it is not. Anne Fadiman, who comes from American Scholar, rarely inserts herself in the story and when she begins to half the story is told. Nor does she reveal anything about herself except as it relates to the story of the little girl, Lia who
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has epilepsy and whose illness shows the great divide between Western medicine and the Hmong . I knew very little about the Hmong before I read this and consider it a great anthropological introduction. For over 2000 years they resisted the Chinese who outnumber them 85 to 1. They did this through stubborness , by clinging to their native culture and when necessary, as was often, moving away and often to higher ground. They never relented and they had a long abiding disinterest in authority. After the Laotian war and the help they gave the CIA a huge number came to the US and this story concerns those in the central valley of CA. What is delightful is the contrast. The Chinese are the least spiritual and most practical and the Hmong are deeply spiritual. The parents of Lia explain their daughter's illness spiritually which does mesh with a modern California hospital and its doctors. The parents can't read so they can follow medication requirements and this is before they come to believe the medications are making it worse. At core, to them epilepsy might be the sign of special shamanistic powers. Not so for the Doctors. What ensues is tragic but might not have been avoidable. Show Less
LibraryThing member bouillabaisse
Superb. I can see why Robert Coles compares this to James Agee's and George Orwell's journalism. Excellent cross-cultural analysis of several different cultures--Hmong, medical field (including differences between clinics and hospitals), social workers, CPS, interpreters, &c.--by way of first
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learning why it's important to examine one's belief systems. I love the Arthur Kleinman quote at the end: "Get rid of the term 'compliance.' It's a lousy term. It implies moral hegenomy." This is a full, well-written, well-researched "narrative" and not a "case study." Reminds me why it's important to: listen, pay attention, to always question one's own assumptions, especially when dealing with another culture. But doing that is not always enough or easy. (This also parallels my thoughts on watching The Wire: there is no simple good/evil dichotomy here--people are often stuck within their institutions and thus certain belief systems without knowing it. Fadiman does a masterful job of interweaving all the different perspectives at the same time questioning her own and watching her own views change over time. Important work for therapists, social workers, of which I am. I like her discussion on the use of cultural brokers v. interpreters. Show Less
LibraryThing member cestovatela
Lia Lee's parents never intended to come to the United States, but when the Vietnam War destroyed their village and left them refugees, they were forced to immigrate. Members of a reclusive mountain tribe called the Hmong, they adapted poorly to American culture and viewed official institutions
Writer and former journalist Anne Fadiman chronicles each side of the story with great empathy and exhaustive detail. Chapters alternate between the story of Lia's illness and the history of the Hmong people, beginning with their folklore and continuing with their involvement in the Vietnam War and difficult assimilation to the United States. At first, these histories seem irrelevant, but by the end of the book, they allow us to see the Lees as a product of their own unique, valid culture -- just as much as the American doctors are a product of our own subjective American value system. Thanks to this meticulous research and outstanding objectivity, the book succeeds at one of literature's most difficut task: posing more questions rather than giving answers. I finished this book in just 3 days, but I know that I will spend many more pondering what makes a good parent or a good doctor and whether we can ever truly label one version of reality right and another wrong.
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with deep suspicion. Nonetheless, when their two-year-old daughter Lia began suffering massive seizures, they carried her to the emergency room of nearby Merced Hospital. That night began an epic clash of cultures that wounded every doctor and family member involved in the case. The Lees, deeply spiritual people, believed that physical illness is caused by a sickness of the soul. They hoped to combine Western medications with traditional Lao healing. In any case, with no knowledge of spoken or written English, they are unable to understand the complex series of medications perscribed by the doctors. Lia's physicians are equally hampered by labor-intensive jobs in a county hospital serving a low-income population. With no money for interpreters, they are overwhelmed by the onslaught of literally thousands of Hmong patients who seem not to value Western medicine. As Lia's seizures worsen, a legal controversy emerges: are her parents fit to be her caretakers?Writer and former journalist Anne Fadiman chronicles each side of the story with great empathy and exhaustive detail. Chapters alternate between the story of Lia's illness and the history of the Hmong people, beginning with their folklore and continuing with their involvement in the Vietnam War and difficult assimilation to the United States. At first, these histories seem irrelevant, but by the end of the book, they allow us to see the Lees as a product of their own unique, valid culture -- just as much as the American doctors are a product of our own subjective American value system. Thanks to this meticulous research and outstanding objectivity, the book succeeds at one of literature's most difficut task: posing more questions rather than giving answers. I finished this book in just 3 days, but I know that I will spend many more pondering what makes a good parent or a good doctor and whether we can ever truly label one version of reality right and another wrong.
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LibraryThing member tjsjohanna
I discovered this book on LibraryThing and am so glad I did. There is so much that is interesting in this book - the story of Lia and the history of the Hmong in Asia, and the struggles of immigrant Hmong whose culture is so radically different from American culture. I'm an idealist, and a believer
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in an individual's right to themselves, so I found it difficult to believe that there could be such a struggle between two cultures - but it is in those struggles that understanding and change occur. While Lia's experience is immeasurably sad, I didn't find the search for ultimate cause very interesting. Things happen - there's no denying that Lia had a severe form of epilepsy that may have taken her life, even with optimal care. I find it amazing and inspiring that her family has continued to value her as an integral part of their family and have taken such painstaking care of her. I can only imagine the stress and burdens they shoulder every day. It is heartening to see that there are people who can be so selfless in their approach to the way they live their lives. I highly recommend this book to anyone who wants to know more about the Hmong, and on a more general level, wants to be challenged about cultural differences. Show Less
LibraryThing member vastard
This is a fascinating and well-researched book about a clash of cultures that occurred when a young Hmong child named Lia was diagnosed with severe epilepsy. For me, the best thing about the book was Fadiman's ability to see the problem from all sides. She did an excellent job describing the same
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situation from both the viewpoint of Lia's highly capable and well-meaning yet somewhat culturally insensitive doctors and the viewpoint of her very committed but uneducated (by Western standards) parents. For anyone who is involved in medical care of recent immigrants, this book could be eye-opening. Show Less
LibraryThing member rosrut
I learned about the difference between Western medicine and Hmong medicine/spirituality. I think this is a very important book for anyone in the medical field, and actually for everyone because this country is full of different cultures and practices and we may not even know it.
LibraryThing member JGoto
The subtitle on the cover of Anne Fadiman’s The Spirit Catches You and You Fall Down (A Hmong Child, Her American Doctors, and the Collision of Two Cultures) aptly describes the content of this fascinating and well written anthropological study. The book centers on Lia Lee, an American born
Several chapters in the book are devoted to the history of the Hmong people, long before and shortly after migration to the United States. Unlike many other immigrant groups, the Hmong came to the US reluctantly, forced to leave their homes in Laos because of reprisals faced for helping the CIA during the Vietnam War. A fiercely independent people, they value their culture and freedom above all. Of all of the Southeast Asian immigrants, the Hmong have been the least willing or able to assimilate into American society. “It is well known that involuntary migrants, no matter what pot they are thrown into, tend not to melt.”
Whereas Americans might consider medical care a small or at least contained aspect of their lives, it is integral in the lives of the Hmong. Traditionally using Shamans to assure that souls are intact and protected from evil spirits even after death, rituals and animal sacrifices were a part of medical care and daily life in general. Even the Hmong name for epilepsy (The Spirit Catches you and You Fall Down) indicates that a simple drug regimen might fall short of an acceptable treatment for the disease. That, combined with Hmong illiteracy and an inability to speak English to medical personnel, put the two sides on an inevitable collision course. On the bright side, Fadiman presents instances where cultural differences are taken into account, “cultural brokers” are employed, and satisfactory results are achieved. The few medical providers that invest the energy and empathy to undertake this type of endeavor are to be greatly admired. I think that Anne Fadiman’s book should be required reading for all students in medical school.
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daughter of recent Hmong immigrants from Laos. Lia develops severe epilepsy at the age of three months. This book is a non-judgmental account of the myriad of cultural misunderstandings between American medical professionals and traditional Hmong parents that ultimately lead to tragedy for Lia Lee. Fadiman skillfully and sensitively reveals the good intentions on both sides of the cultural divide. Moving back and forth between the family and doctors, Fadiman presents the “facts” of Lia’s treatments retold from both points of view. Unsurprisingly, the accounts were radically different from one another.Several chapters in the book are devoted to the history of the Hmong people, long before and shortly after migration to the United States. Unlike many other immigrant groups, the Hmong came to the US reluctantly, forced to leave their homes in Laos because of reprisals faced for helping the CIA during the Vietnam War. A fiercely independent people, they value their culture and freedom above all. Of all of the Southeast Asian immigrants, the Hmong have been the least willing or able to assimilate into American society. “It is well known that involuntary migrants, no matter what pot they are thrown into, tend not to melt.”
Whereas Americans might consider medical care a small or at least contained aspect of their lives, it is integral in the lives of the Hmong. Traditionally using Shamans to assure that souls are intact and protected from evil spirits even after death, rituals and animal sacrifices were a part of medical care and daily life in general. Even the Hmong name for epilepsy (The Spirit Catches you and You Fall Down) indicates that a simple drug regimen might fall short of an acceptable treatment for the disease. That, combined with Hmong illiteracy and an inability to speak English to medical personnel, put the two sides on an inevitable collision course. On the bright side, Fadiman presents instances where cultural differences are taken into account, “cultural brokers” are employed, and satisfactory results are achieved. The few medical providers that invest the energy and empathy to undertake this type of endeavor are to be greatly admired. I think that Anne Fadiman’s book should be required reading for all students in medical school.
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LibraryThing member Liciasings
It was a long time ago I read this book, but I do remember it being powerful and eye-opening. Great story and well-written; I was teaching Hmong children at the time, and it gave me some interesting insights into that culture. I'll probably read it again someday.
LibraryThing member ELCLBookclub
We met to discuss Anne Fadiman's informative, eye-opening book. Fadiman gives readers a in-depth look at the clash of two cultures - the Hmong culture and the American medical system. It is difficult to explain the frustration we all felt reading about a Hmong child with epilepsy and the American
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doctors who tried to save her. Fadiman helps the reader understand the Hmong culture, their beliefs, the way they view life and how this is in direct opposition to American medical practices. Show Less
Subjects
Awards
LA Times Book Prize (Finalist — 1997)
National Book Critics Circle Award (Finalist — General Nonfiction — 1997)
Salon Book Award (Nonfiction — 1997)
Language
Original language
English
Original publication date
1997
ISBN
0374525641 / 9780374525644