The Spirit And You Fall Down Sparknotes

The Spirit Catches You and You Fall Down: Critical Book Review

Fadiman’s The Spirit Catches You and You Fall Down looks that the problems of culture clash and cultural misunderstanding in the Western medical field. Fadiman’s focus is on the case of Lia Lee, an epileptic girl who comes from a Hmong family in Merced, and how her condition was viewed differently between her parents and the doctors treating her at Merced Community Medical Center (MCMC). Lia’s parents believed in traditional Hmong practices associated with holistic medicine while the doctors at MCMC believed in the Western medical practice of allopathy. Throughout the novel, we see how Fadiman aims at placing herself in a neutral position and analyzing Lia’s case unbiasedly through

gaining insight of the Hmong culture and learning more about the Western medical culture. Fadiman does this by studying several book dealing with Hmong history, interviewing Lia’s parents, and speaking with Lia’s doctors. Fadiman uses the tension between the Lia’s parents and the MCMC doctors as a way to portray that cultural collisions and cultural misunderstandings in the medical field are rooted to differing cultural/religious beliefs and that neither the American doctors nor Lia’s Hmong parents are to blame. The acts of respecting, empathizing, and learning about one another’s culture allow for better care by creating stronger doctor-patient relationships and eliminate the estrangement felt by a culture in the presence of another.
Fadiman supports her argument mainly through the presence of the language barrier between the two cultures and how it affects trust between each other.

Multiple times throughout the novel, the miscommunication between Lia’s doctors and Lia’s parents led to the mistreatment and overall poorer quality of care for her health. During Lia’s first emergency room (ER) visit, Lia’s parents were unable to describe her seizure symptoms which led to her diagnosis of pneumonia and ultimately detained her actual diagnosis of epilepsy and treatment plan (Fadiman, 26). Additionally, during Lia’s other hospital visits communication between the nurses and Lia’s parents was hindered which not only led to the estrangement of Lia’s parents from her treatment but also led to them feeling a lack of being

acknowledged.
The author also uses the moments of the doctors’ cultural insensitivity to further exacerbate the distrust of the Lee’s faith in Western medicine. Lia’s parents, who viewed their traditional Hmong practices as being correct, did not like the fact that she was given a great deal of medicine. They believed Western medicine to unnatural and only wanted Lia to receive a sufficient amount of medication that would allow her convulsions to stop so that her care could return to them at home. Since the etiology of Lia’s seizures was unknown, the doctors continuously changed Lia’s prescriptions to determine the medication that worked the best for her (Fadiman, pg. 46). After being discharged from the hospital, Lia’s parents were constantly noncompliant with her medication regimen which may have been partly due to the language barrier but ultimately it was based on the fact that they viewed medication as being bad for the soul. This non compliance could have been avoided if the doctors understood the type of treatment which in parents wanted. Later on in the novel, Dr. Neil Ernst agreed with Lia’s family that perhaps prescribing one medication (rather than three) would have eliminated the noncompliance and built trust between Lia’s family and the doctors (Fadiman, 257).
Thirdly, Fadiman uses eight of Dr. Arthur Kleinman’s questions to as an approach eliminate cases where culture clash occur. Essentially, doctors would be aware of the patient’s beliefs and the patient would know what to expect regarding the doctor’s treatment. Fadiman uses Kleinman’s point of view to show that both cultures are powerful in their own way and both should be accepting of each other’s beliefs. Kleinman states, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal with someone else’s culture” (Fadima, 261). Fadiman used his idea as a way to achieve cultural understanding and sensitivity.
I believe that the authors account of Lia’s case was quite accurate secondary to her largely unbiased position.

She clearly portrayed the Hmong beliefs and their origins through her detailed explanation of the Hmong customs and history. She also uses keen details to explain the medications and medical procedures over the course of Lia’s treatment. It was evident that Fadiman entered the case with an open mind and avoided cultural/religious misunderstanding. While her explanation of the Hmong culture using the “fish soup” method laid a foundation for which the novel would build upon, I believe that maintaining aroused on the subject was slightly difficult. Fadiman also uses her knowledge of medical education to explain that blame for the culture clash cannot be assigned to the doctors since they were not educated on that matter (Fadiman, 61). Even though Fadiman attempts maintain an unbiased position on the issue, I believe her claim regarding doctor was biased. The author states, “Medicine, as it is taught in the United States does an excellent job of separating students from their emotions. … Dissociation is part of the job. … Neil Ernst avoided Lia Lee after she returned from Fresno with irreplaceable brain damage(he couldn’t bear it) (Fadiman, 275, 276). In the beginning of the novel the author explained how doctors Neil Ernst and Peggy Philp were some of the only people to provide satisfactory treatment for Lia (Fadiman, 42). With this being said, I believe that

Fadiman’s statement is not correct with respect to their medical care. Since Lia’s hospital services were under Medi-Cal and were subject to low reimbursement, the services offered by doctors Neil Ernst and Peggy Philp were mostly out of the goodness of their hearts. Even though Dr. Ernst believed that putting Lia up for adoption was the best decision for her at that time, he still experienced emotional difficulty in his decision. Dr. Ernst’s care for Lia was on a personal level rather than a money making scheme. Every time Lia returned to the ER was because she was experiencing the most severe seizure of her life, he did not expect her to be in septic shock and therefore did not place her on antibiotic treatment (Fadiman, 256). He avoided Lia after she returned to Merced possibly because he felt guilty for not being able to treat her within the allotted time essentially preventing her brain damage from occurring. With my first hand experience in the ER, I believe that most doctors dissociate themselves from the patients emotions in order to treat patients more efficiently however Dr. Ernst was an outlier in this case. In my opinion, he was attached to Lia at a more personal level than the average doctor.
After reading the title of the novel The Spirit Catches You and You Fall Down, I assumed the book would be about religion and the pursuit of one’s goals however after reading the subtitle “a Hmong Child, Her American Doctors, and the Collision of Two Cultures” I was excited to start reading a book that I could relate to through experience. I am myself a first generation American and have dealt with the culture clash associated with a language barrier and cultural traditions. I grew up being taught the Greek language, eating traditional Greek foods, and greeting a people with the double-cheek kiss. As soon as I started school and realized that my teachers and fellow classmates were not partaking in the same rituals and experienced a great sense of alienation. I found it increasingly frustrating when my parents were having more difficult of a time expressing their concerns to teachers, coaches, and even friends. Over the years, I maintained an open mind and adapted to these Western traditions by abandoning the Greek traditions (only at school). As a result of adopting these new beliefs and values, my understanding and appreciation for intrapersonal communication, education, sports, music, and the world overall has increased tremendously.
I now work as a Saint Agnes Medical Center (SAMC) ED scribe, and volunteer at CRMC and various other clinics. All of these environments are subject to culture collisions between patients and doctors, as there are several patients with language barriers who present for treatment. I agree with Fadiman’s idea of cross cultural education and its potential to create better medical care. The use of interpreters for patients with language barriers still creates a small disconnect between the patient and the doctor. Even though both parties concerns may be expressed I believe that the art of direct communication enhances trust in people. Even though the number of culturally understanding people is increasing, I believe the length of time it takes to bridge the gap between cultures in the United States will be several decades.