The Spirit Catches You and You Fall Down

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In many respects, Fadiman’s The Spirit Catches you and You Fall Down is nothing short of excellent reporting; an anthropological medical narrative at its absolute best. The book quintessentially captures the general Hmong experiences in a foreign nation, and specifically in their interaction with modern medicine. The investigative and thoroughly researched anecdote follows the life of Hmong immigrants (“refugees”) in the United States with a special focus on the Lees’ family. In particular, the Lees take center stage not only as one of the key “inadvertent” antagonists, but also because of their daughter Lia Lee who is caught by the spirit at the tender age of three months. As a result of her health condition, Lia is constantly in and out of different hospitals and receives over 20 prescription changes from several medical practitioners before finally falling into a vegetative state after the “Big One” (Fadiman, 2012, p. 157) leaves her “quadriplegic, spastic, incontinent, and incapable of purposeful movement” (p. 225). Her primary physicians, and also the other key antagonists, are Neil and Peggy.

            The Spirit Catches you and You Fall Down is a tale only likened to Shakespearean tragedies as it opens up the readers to a world of cultural collisions and barriers with dire consequences. In her preface, Fadiman poses several important questions with no particular right answer but endless possibilities for analytic conclusions. Through her literary masterpiece, Fadiman seeks to discern what constitutes a good parent or a good doctor. To find the complex answers and determine where to place the blame on Lia’s unfortunate, and arguably preventable tragedy, the author wonders whether: (i) Neil, Peggy, and Dan were good doctors, and (ii) whether the Lees are good parents. She also delves deeper into the disheartening issue of immigrants’ suffering and what sociologists refer to as “role loss”, and the devastating effects it has on refugees or involuntary immigrant communities such as the Hmong.

            On whether Neil, Peggy and Dan were good doctor or not, it is evident that Neil and Peggy were committed to their profession as supervising pediatricians and they are determined to treat Lia using the best medical practices despite the tremendous amount of frustration at the barriers presented when dealing with Lia’s family. At one time, Neil and Peggy come in to see Lia at three AM in the morning which shows their unwavering heroic determination to help their young patient. Importantly, although Neil and Peggy strive to ensure that the language barrier does not hinder Lia’s care, the two doctors are never keen on understanding her culture which is vehemently against contemporary medication. As a result, the physicians meet the Lees with non-compliance accusations and disgust, to which the Lees respond with suspicion and distrust; especially when Neil arranges for Lia to be taken to foster care without any consultations. What the two doctors failed to understand is that they needed to compromise and accept the Hmong’s concept of healing the soul.

            According to Dr. Dan Murphy who was better versed with Hmong traditions, “When you fail one Hmong patient, you fail the whole community” (p. 253). However, Fadiman finds Neil and Peggy’s actions morally satisfying although “whenever a patient crossed a compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle” (pg. 265). In addition, Francesca Farr who had considerable success with Hmong patients compared to Neil and Peggy used the following working principles when making house calls: (i) she always had a cultural broker; (ii) she worked within the confines of Hmong family traditions and beliefs; (iii) she never patronized, criticized or threatened her patients; and (iv) she did not carry her own beliefs to her patients’ homes or dwelled on Western medicine. Similarly, when asked for retroactive suggestions for Neil and Peggy, Dr. Kleinman said that they needed to divest themselves of the “compliance” term, employ more mediation and less coercion, and lastly, try to understand that although the Hmong had a powerful cultural background, the biomedicine culture also carried its own set of biases, interests and emotions which hindered the ability of the two doctors to successfully deal with a foreign culture.

            On the issue of whether the Lees were good parents or not, it is evident from Fadiman’s book that the lack of an interpreter at the hospital was the root cause of all problems that befell Lia. The Lees did what they perceived as best for Lia, including overdosing her when they thought the medicine was working, or withholding her medication when they thought it was doing more harm than good. As parents, Nao Kao and Foua kissed, loved, caressed Lia extravagantly and dressed her exuisitely. But as care givers in a modernized medical setting, they failed miserably. From the book we can see that Neil thought Nao Kao stonewalled him most of the time, while Peggy thought the mother was a little crazy because a battalion of healthcare workers had burnt-out at the Lees’ home attempting to educate the “non-compliant” Foua.

            Conversely, a closer scrutiny of the Lees family reveals a great deal about Nao Kao’s and Foua’s parenting skills or the Hmong way of bearing and raising children. Nonetheless, while the medical system in American diagnosed Lia as an epileptic and prescribe anticonvulsants, the Lees on the other hand, and in line with the Hmong’s 4000-years old traditional beliefs, view Lia’s predicament (qaug dab peg) as both a blessing and a curse that requires spiritual intervention such as animal sacrifices or a visit from the shaman. For instance, Nao tells Fadiman during one of their many encounters that “the only way to cure that kind of sickness is to sacrifice a dog, and this country won’t allow you to kill dogs” (p. 101). As the doctors work tirelessly to save the body, the Lees, guided by deeply rooted Hmong principles believe that they should be concentrating on saving Lia’s soul instead.

            For this reason, the cultural miscommunication brings out the Lees as noncompliant, and to an extent, uncaring. However, contrary to this perception, the Hmong are infamous for how gentle they treated their children. Mothers never parted with their infants or young children, always carrying them on their backs at daytime and holding them in their arms when sleeping during the night. In comparison to Caucasian mothers, Hmong mothers are considered to have more physical contact with their babies. Lia had been brought up in this environment with even more special treatment since the Lees believed that her epilepsy was not an affliction, but a blessing. To them, Lia was an anointed soul and her condition spurred a mixture of pride and great concern.

             To sum up on the question of whether the Lees were good parents or whether Neil, Peggy and Dan were good doctors, the author says this about both sides in her preface, “I realized how much I liked both sides and how hard it was to lay the blame at anyone’s door” (viii). This is especially true because although both the doctors and the parents wanted what was best for little Lia, the Lees’ conceptions of what caused Lia’s ailment and the appropriate treatment are totally different in many aspects. What the Lees exhibited was neither lack of common sense nor stupidity, it was love. Throughout the book we can see from various occasions that Foua planted special herbs for Lia, brought in a shaman, chewed food in her own mouth to feed the vegetative Lia, and sacrificed chickens and pigs. The doctors on the other hand follow due procedure in providing medical care and even involve the police and a judge at some point in order to ensure Lia was well taken care of despite the fact that her parents appeared obstinate. Most importantly, the Hmong believe that parents are responsible for all the decisions made on their children’s welfare which is why the Lees perceived the American doctors as overstepping their mandate because they were not part of the family.

            Culture collision in healthcare is not the only problem presented in Fadiman’s illuminating investigative journalism. Another key factor discussed in the book is the problem of “role loss” suffered by the Hmong immigrants, and by extension, other refugees in the United States. According to Fadiman, many Hmong claimed that they never dreamed of America but constantly dreamed and longed for their home in Laos. Their psychological reality was both empty and full in the fact that most Hmong were empty of the newly encountered life experiences and ideas, but full of their past glory. Dealing with the issues that threatened their old identities was even harder. Role loss was, according to the author, was the most corrosive of all stresses among the Hmong community in America.

            While the elderly were held in high esteem in the family hierarchy, the roles were arbitrarily reversed in the American society because the young were easily learned the American culture and customs thereby becoming more valuable to families struggling to make adjustments. Parents depended more on their children because they could neither speak English, read, drive, or find meaningful employment. Many of them were also on welfare and felt completely stripped of their dignity as prolific members of their former society in Laos. Consequently, the respect that the young accorded to their elders was quickly fading away which led the elderly Hmong to view any assimilation as a threat and an insult. For instance, in the chapters devoted to the history and ethnic identity context of the Hmong, the author characterized them as “independent, insular, antiauthoritarian, suspicious, stubborn, proud, choleric, energetic, vehement, loquacious, humorous, hospitable, and generous” (pg.223). However, a former judge, Moua Kee now worked the night shift in a shop after initially working in a box factory. Similarly, Major Wang Seng who commanded 10, 000 troops back at home was now a part-time liaison in a church after being jobless and dependent on his wife for nearly five years which was emasculating. Weng says of himself and others in his predicament, “We have become children in this country” (p. 221).

            The same problem of adjusting to a new society or assimilation can be traced to other immigrant groups or refugees living in America. Fadiman observes that “even legal immigrants are unlikely to be received with open arms” (p. 249). The mismatch in culture is apparent in every aspect of the foreigner’s lives. “It would be hard to imagine anything further from the vaunted American ideal of assimilation, in which immigrants are expected to submerge their cultural differences in order to embrace a shared national identity. E pluribus Unum: from many, one” (p. 182).

            In light of the above discussions, my view of immigrants and refugees is forever altered and I have developed a new found sense of respect and empathy for such foreigners who are expected to not only abandon their traditional ways of life embedded over years, but also expected to absorb a new lifestyle in what may sometimes be an unwelcoming society. The discussion also changed the way I viewed or understood “helping others” with regard to cultural diversity.    

            In conclusion, Anne Fadiman’s non-fiction exploration of medicine and culture helps us in understanding how cultural misunderstandings can try the persistence and faith of an ancient culture, as well as bring the most sophisticated of medical systems to an absolute halt. After reading Fadiman’s chronological account of Lia’s tragic ailment and the Hmong culture, I have found great admiration and respect not only for the Hmong, but also for other cultures as well. I especially note that every culture views their practices as the most appropriate and that their culture knows best because everything else is perceived as sub-par.


Fadiman, A. (2012). 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.

October 13, 2023




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