In The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, author Anne Fadiman explores the complexity of a cultural clash through communication and interaction between the Hmong minority and biomedical culture in the United States. In broad terms, her book classifies as a modern-day case of cultural anthropology that depicts the complications of unprepared cross-cultural communication and lack of assimilation. Fadiman documented the saga of the Lees, a Hmong family who immigrated to Merced, California after nation-wide problems in their homeland of Laos and China (Fadiman 5). Their story exemplifies the struggle with biomedicine in the United States by detailing the story of the Lee’s severely epileptic daughter Lia and reflecting on the factors and outcomes of her life and death.
The Hmong Culture
To understand the events and clashes between Lia’s family and her medical staff, it is necessary to understand who the Hmong are. Fadiman dedicates several chapters of her book to explaining the depths of the Hmong culture in order to strengthen her reader’s understanding of the unfolding dilemma between the Lees and the American doctors. In the terms of Dr. Gary Weaver, a professor and Executive Director of the Intercultural Management Institute at American University, the Hmong are categorized as more high-context and gemeinschaft culture (Weaver 15). A concrete instance of the beliefs of the Hmong is their interpretation of illness. Sukey Waller, a psychiatrist at the Merced Community Outreach Services stated, “Psychological problems do not exist for the Hmongs, because they do not distinguish between mental and physical illness. Everything is a spiritual problem,” (qtd. in...
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...ne in medical textbooks (Fadiman 270) since the tale of Lia has gone public.
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures shares the journey of cultural illiteracy from the Hmong and American side. Fadiman states, “In 1995, for the first time, the national guidelines for training psychiatry residents stipulated that they learn to assess cultural influences on their patients’ problems,” (Fadiman 270). Though the unfortunate events that occurred were definitely able to avoid now, at the time, there was no standard set of actions and procedures to take in order to provide the best health care to different cultures. Fadiman truly succeeded in showing the reader that good intentions and compassion must be weighed more heavily when analyzing events and the consequences must be met with an objective eye.
In their pursuit of assimilating and calling the US home, they had forged a new identity of Hmong Americans. (Yang, 203) Being Hmong American meant striving to move up the economic ladder and determining one’s own future. They understood that for them to realize their American dream and their “possibilities”, it could only be done so through “school”. (Yang, 139) Yang realized her dream by attaining a Master’s of Fine Arts from Columbia University and publishing books about the Hmong story.
Douglas, Rosenkoetter, Pacquiao, Callister, Hattar-Pollara, Lauderdale, Milstead, Nardi, & Purnell (2014) outline ten guidelines for implementing culturally competent care; knowledge of cultures, education and training in culturally competent care, critical reflection, cross-cultural communication, culturally competent practice, cultural competence in health care systems and organizations, patient advocacy and empowerment, multicultural workforce, cross-cultural leadership, and evidence-based practice and research. One specific suggestion I will incorporate is to engage in critical reflection. This is mentioned both by Douglas, et al. (2014) and Trentham, et al. (2007) as an important part of cultural competency. I will do this by looking at my own culture, beliefs, and values and examining how they affect my actions. I will use this information to better inform my day to day practice when working with patients with a different culture than my
How would it feel to flee from post-war Communist forces, only to face an ethnocentric population of people in a new country? In Anne Fadiman's The Spirit Catches You and You Fall Down, a portrait of a disquieting, often times touching, ethnography (i.e. a book that details particular data of an extended period of time an anthropologist spent living closely with a community of individuals during his or her field work) of Fadiman's experience living in Merced, California, which was home to the largest population of Hmong refugees, such as the Lee family, from Laos who suffered mass confusion when trying to navigate the American health care system. Because the Hmong could not speak sufficient English until the children gained language skills native to the United States, residents of California were not accepting of the Hmong community. Fadiman aims to better understand how knowledge of illness among Hmong and Western medical practitioners differ, which pushes the reader to understand how the complicate medical treatment in the past as well as the present from a perspective of an American observing a Hmong family's struggle with the system. In America, it isn’t uncommon to be judged for your clothing, your house, or the amount of money your family makes, so it is easy to believe that the Hmong people were not easily accepted into American society. As a whole, ethnocentrism, or the tendency to believe that one's culture is superior to another, is one of America's weaknesses and this account proves ethnocentric behavior was prominent even in the 1970-80's when Fadiman was in the process of doing her fieldwork in post-Vietnam War Era California.
The book I read to examine multicultural issues and cultural biases was The Spirit Catches You and You Fall Down, by Anne Faldiman. I found it helpful to use Google maps to get a visual of the location Hmong refugees came from in Laos and mentally trace their journey across the Pacific to settle in Merced, CA. There are two main cultures discussed in this book which includes the subordinate Hmong Lee family and the dominant White American doctors who tried to help Lia with her medical or spirit issues depending on which culture you asked. Faldiman stated in the preface, “I have always felt that the action most worth watching is not at the center of things but where the edges meet.” This statement would hold so much relevance because Lia’s treatments could have been less stressful if the two cultures reached a point of intersectionality. This is also congruent with what Tatum mentioned in Why are All the Black Kids Sitting Together in the Cafeteria concerning, “Changes in immigration policy in 1965 dramatically increased Asian immigration, significantly altering the demographic makeup of the Asian Pacific American community.” In order to have a full
The Hmong people, an Asian ethnic group from the mountainous regions of China, Vietnam and Laos, greatly value their culture and traditions. The film “The Split Horn: Life of a Hmong Shaman in America” documents the seventeen year journey of the Hmong Shaman, Paja Thao and his family from the mountains of Laos to the heartland of America. This film shows the struggle of Paja Thao to maintain their 5000 year-old shamanic traditions as his children embrace the American culture. Moreover, the film shows that one of the major problems refugees like Paja Thao and his family face upon their arrival to the United States is conflict with the American medical system. Despite the dominant biomedical model of health, the film “The Split Horn” shows that
As our textbook states, “Communication includes the willingness of individuals to share their thoughts and feelings” (Purnell, 2103, p. 21). To that end, the Hmong people are primarily illiterate. For this culture, they have a belief that Americans are rude because direct eye contact is maintained when conversing, as well as asking direct questions. In order for there to be successful education regarding the risks of cupping or coining as well as needle pricks, it is important to know that when speaking to someone of the Hmong culture to use quick glances without starting and to initiate a light conversation prior to asking anything regarding their beliefs, health, etc. The Purnell Model of Cultural Competence states that the domain of high-risk behaviors is one area that healthcare providers can make a significant impact on a patient’s health status (Purnell, 2013, p. 30). Advice to the parents, under these circumstances along with other obstacles that could potentially be faced due to the very different cultural aspects, would best be given via one-on-one or through family counseling techniques. From what I have learned so far from our readings, spirituality plays a very important role in a cultures health and well-being. Knowing the beliefs pertinent to the culture you are treating allows you as the provider to better assist them to attaining better health and well-being. Trust is also paramount and it is very clear that to interfere with a person’s spirituality could possibly hinder their physical recovery and actually cause physical
The traditional Hmong live a horticultural society they depend on domesticated plants, they are well-adapted on soils of the tropical rain forests and poor soil places which are unsuitable for intense agriculture. Prehistoric Hmong are thought to have moved from Eurasia and made a few stops at Siberia. As their custom they settled in the highlands (mountains) from Vietnam and Laos and later in Thailand. They inherited the name “Miao”, from living in the mountains. Today Five million Hmong reside in China, more than any other country. The Hmong people have straight black hair and have a short, sturdy stature.
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The purpose of the assessment is to address the competence of different cultures. As a number of Haitian immigrants in to the United States, it continues to grow at a steady rate (DeSilva, Gonzales-Eastep, Grey, & Nicolas, 2006). It is very important that mental health providers become better informed, and develop the skill sets necessary to combine the providers’ and clients’ cultural backgrounds into the treatment (DeSilva, Gonzales-Eastep, Grey & Nicolas, 2006). I will be conducting an assessment on, Mrs. Hudson an Haitian American woman who was referred by her primary care doctor, because of symptoms that; she is experiencing when she leaves her home. This is Mrs. Hudson’s first time to a mental health counselor.
The main coping mechanism, then, became suppressing of the memories and emotions attached to the traumas of the Vietnam Wars. Their home served as the host of these demons, but the demons impacted parenting styles. Thi acknowledges that her parents taught her and her siblings many lessons, some intentional but others, quite the contrary. It was the “unintentional ones [that] came from their unexorcised demons and from the habits they formed over so many years of trying to survive;”(“The Best We Could Do,” 295) these lessons were indeed unintentional because just like the suppressed communication, they derived weak communication between the parents and the children. In Min Zhou’s article “Are Asians Becoming ‘White’?” she concludes by including a picture of a Vietnamese family celebrating the 1998 Lunar Year, looking happy. This happy family in the article is much like the Bui family because on the outside, they appeared happy, but inside their home and their hearts, a darkness
In conclusion, three things could have solved the cross-cultural problems between the Hmong and the American doctors. The doctors should have had more compassion toward the Hmong people, who have been discriminated and put down for very many years. They should have been more understanding toward the Hmong's belief and worked with and not undermine it. Lastly to compromise in all aspects in a relationship no matter what kind is a two way street, and if one party does not respect the other then the feeling will be reciprocated. You have to come to a middle ground or everything will fall apart like in Lia's case.
She heard about the Hmong through a friend, and so she spent 4 years living in Merced, California and another 5 writing this book. She attempts to stay fairly neutral in her writing, though through her time with the Lees, she confesses that her writing may appear biased toward the Hmong culture rather than toward the Americans. However, in the end she could not blame one side or the other for the unfortunate tragedy of Lia, who got hit in the cross-fire between these two cultures. Her theoretical view is a type of cultural relativism. Neither the Hmong nor the Americans could emerge as the better culture. She does not address any questions about direct unethical practices. The Hmong did not practice human sacrifices, and the animals they did sacrifice were theirs. She does seem to believe that every culture has its weak and strong
What would it be like to come to a country and not understand anything about its health care system? To many this would be a very daunting task. Unfortunately, this is the scenario that the Lee family has to deal with in the book The Spirit Catches You and You Fall Down by Anne Fadiman. The Lee family, and the other thousands of Hmong immigrants, try to understand and navigate the complex and sometimes confusing health care system of the United States. As the book points out, the values and ideals of the Hmong culture and the United States health care system are not always the same and sometimes come into great conflict with each other. Lia Lee was unfortunately the person stuck in the middle of this great conflict.
Anthropological studies on language and communication would be directly related to Lia’s case for a few reasons: Lia and her family were Hmong, her parents could not read or write, they didn’t give her enough medication. Also, Lia was taken away from her parents because of language and communication barriers that led to her parents not administering her medication at all, as well as interpreters not being clear about what to give her.
Lipson, J.G. & Dubble, S.L. (Eds). (2007). Culture & clinical care. San Francisco, California: The Regents, University of California.