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 culture clash between the Hmong parents of an epileptic girl and the American doctors at Merced Community Medical Center(MCMC). The novel begins with the predicament of where to assign responsibility for the maltreatment of Lia Lee’s epilepsy. Fadiman uses the tension between the parents of epileptic Lia Lee and the doctors of MCMC as a way to show that the Western culture can be insensitive to other cultures. As the novel progresses, it becomes evident that this battle is rooted to differing cultural/religious beliefs and that neither the American doctors nor Lia’s Hmong parents are to blame. All of which could

have resolved through respecting and empathizing with one another’s culture. The novel depicts characters such as Lia’s parents, Nao Kao Lee and Foua Yang Lee, who were unable to understand the significance of the American medical system and other characters like the social worker, Jeanine Hilt, who were more sensitive to cross-cultural understanding.
Foua Lee, Nao Kao Lee, and actually most the Hmong community were skeptical of whether or not to trust the “white people” of the American medical culture. This is deeply associated with the history of the Hmong people, whose culture has been subject to the opposition and restrictions of other cultures in essence preventing them from practicing their cultural rituals. The distress that they experienced at the idea of losing has caused them to evacuate their area of residence. The Hmong people would rather run away, battle, and even die than being submissive. This has greatly influenced their ability to trust people of other cultures and to be swayed by other culture’s customs such as the American medical professionals. Lia’s medical case played a key factor in determining whether the Hmong people of Merced, California would trust the medical professionals at MCMC. Many of the medical professionals did not see a purpose in attempting to communicate with the Lee’s because of the language barrier. This lack of communication led to their belief that they were being taken advantage of. Despite this innate distrust, Lia’s family held trust in Jeanine Hilt, one of the social workers.
Jeanine was the only “white” person who fought for the Lee’s beliefs through effective cross-cultural communication. She was also the only person to get Lia back to her family as her episodic seizures became more severe and occurred more frequently. After succeeding in this task, she aimed at educating Lia’s family on the importance of being compliant with Lia’s medication regimen. She also sought out to understand Nao Kao and Foua Yang’s skeptical attitude towards use of unnatural substances such as medicine. Jeanine was very open to communication and genuinely interested in understanding the opinions of the Lee’s regarding the treatment of Lia. By expressing these attitudes towards the Hmong people, she was able to understand and explain the Lee’s (and the Hmong culture’s) feelings towards Lia’s epilepsy. Jeanine used the Lee’s daughter, May, to translate the conversation between her and the Lees. As a result, she appeared to be culturally empathetic and approach them in a caring manner. By having an unfamiliar translator in the room the tension of the situation would have increased in essence hindered her effectiveness of communication. She took Lia’s case very personally as she made it her mission to help Lia’s family fight against the medical system’s unwillingness to communicate. Jeanine’s openness allowed her break down the communication barrier between Lia’s family and the medical professionals. As long as she kept the line of communication open between herself and Lia’s family, she allowed communication between the Lees and the medical staff at MCMC. The empathy expressed by Jeanine was amplified due to the fact of understanding the burden of a chronic illness through her asthma and because she admired the connectedness of the Hmong community. Because of the strong feelings Jeanine had towards the Lia’s family, the Lees regarded her as very trustworthy.
Even though Jeanine played a proactive role in understanding the Hmong culture, Nao Kao did not attempt to understand the significance of the American medical system.

Nao Kao had great appreciation for Jeanine’s actions towards being understanding of the Hmong culture however he believed that he was not required to reciprocate the action. He never really made an effort to be part of a society that was antagonizing to his beliefs. Fadiman writes “It was typically Hmong for patients to appear passively obedient – thus protecting their own dignity by concealing their ignorance and their doctor’s dignity by acting deferential – and then, as soon as they left the hospital, to ignore everything to which they had supposedly assented” (Fadiman, 68). The fact that Nao Kao agreed that he would administer Lia’s medicine instead of attempting to explain that he does not understand how to administer the medications or that it is against his religious beliefs, he gives the doctors a false impression that Lia will be safe at home. Even though the medical professionals viewed Lia’s grand-mal seizures as an illness, The Lee’s considered Lia as being blessed. According to Hmong culture, it is believed that people who are born with epilepsy are believed to be blessed and bound to have powers of divination and healing, like a shaman. The Hmong called this “qaug dab peg,” or “the spirit catches you and you fall down.” The Hmong believed in the relationship between epilepsy and the concept of spirits however the medical professionals failed to do so. Despite the fact that the Hmong people viewed epilepsy as being a blessing, hated the American medical culture, and were unable to communicate effectively, they also understood the danger of the disease and some of the unintentional outcomes. The French missionary, Francois Marie Savina, stated “attributed their ethnic durability to six factors: religion; love of liberty; traditional customs; refusal to marry outside their race; life in

cold, dry mountainous areas; and the toughening effects of war” about his first impression of the Hmong people in 1924 (Fadiman 208). Fadiman shows that even after being in the United States for over a decade, they have adhered to their Hmong traditions and shown little interest in learning to speak English because of the six factors listed above. The Hmong ethnicity is known for keeping its ways, and Nao Kao was no exception. The combination of the Hmong culture and the role Nao Kao plays in the Hmong culture hindered the Lee family from communicating to the MCMC medical staff directly.
This quote by Fadiman, “I have come to believe that her life was not ruined by septic shock or noncompliant parents but by cross-cultural misunderstanding” (Fadiman, 262) makes it clear that while Lia was not only harmed physically by her epilepsy but also culturally through the conflicts between the two. These conflicts included: language barriers, religious misunderstandings, and stereotypes. The language barrier was the root of Lia’s multiple misdiagnoses
The Lees finally understood that administering Lia’s medicine regularly was necessary and the medical staff realized why they were hesitant in exposing Lia to so many unnatural substances. Lia’s health finally improved after both entities understood each other even more. Lias illness was a way for both cultures to meet together in “a little medicine, a little neeb, or soul” or compromise. This refers to the fact that if the MCMC doctors attempted to learn about the Hmong beliefs and rituals, then Lia would not have suffered as much. Failure in realizing this led to Lia’s final seizure and ultimately her brain damage. In the end of the novel, the doctors regarded Lia’s life as most important while the Hmong people regarded her soul as being the most important. Both sides should have realized that the opposing side contained characteristics in which could offer them great insight. Both sides recognized their faults and came together because of the love they had for Lia. The doctors loved Lia for her lost potential while her parents loved her because she was and always will be their beautiful child. At the end of the novel Fadiman reflects on Lia’s case by saying, “I do not know if Lia would be able to walk and talk today had she been treated by Arthur Kleinman instead of by Neil Ernst and Peggy Philp. However, I have come to believe that her life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding” (Fadiman 262). Jeanine and eventually the MCMC staff was able to understand that other cultures have great things to offer if one attempts to show cultural empathy. Hopefully one day every doctor and even Nao Kao will be able to show this empathy.
Overall, this novel left me feeling quite sad due to the fact that people neglect to create an understanding with people of another culture. Especially when it deals with a situation such as life or death. After realizing that the novel dealt with the medical system of the Central Valley, I grew with excitement in that it would inspire me to continue pursuing a career in the health industry however it failed to do so. This side of healthcare is quite depressing. I reacted in anger when reading about Dr. Ernst’s decision which led to Lia being taken away from her parents. His decision was made clearly out of frustration which prevented him from seeing both sides of the situation and realizing what is best for Lia.