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Summary Of The Spirit Catches You And You Fall Down By Fadiman

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The Spirit Catches You and You Fall Down by Anne Fadiman, explores cultural competence, ethics in medicine, and the provision of culturally competent health care in the United States by following a family of Hmong culture in their struggles with mainstream U.S. society and healthcare. Fadiman has implemented her studies to highlight the differences between Hmong and Western practices and perspectives on health care, illness, spirituality, and the body. Through her extensive research, Fadiman is able to express cultural differences and the impact ignoring this crucial piece can have. Healthcare in the U.S. is described as the best in the world, but Fadiman is able to highlight the weaknesses this healthcare system has in regards to culturally …show more content…

They did not know english and were used to using herbal remedies and traditional healers to treat their health concerns and ailments. Lia Lee is one of their 7 children, and starts displaying symptoms of a seizure disorder a 3 months old. This is where the cultural clashes begin as her parents struggle to find meaning and answers to their daughters strange behaviors. We learn briefly of the Hmong culture and spiritual beliefs that are essential to comprehend when trying to understand the differences between cultures. To the Lees, Lia’s seizures are very frightening, but are also a sign of a connection to the spiritual world. “The noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as qaug dab peg, which means ‘the spirit catches you and you fall down (Fadiman, 2007 p.20).” In the belief of the Lee family, Lia’s condition was as revered as it was scary. A person with qaug dab peg was traditionally held in high esteem in the Hmong culture and were believed to have a future of an honored healer and shaman. This is where the conflict begins as the Lee’s are clearly frightened for their daughter, they have a belief that her seizures will provide her with a life of …show more content…

Kleinman for any retroactive suggestions for Lia’s pediatricians. He said he had three: “Get rid of the term compliance; second, instead of looking at a model of coercion, look at a model of mediation; and three, understand that as powerful as the culture of the Hmong patient and her family is on this case, the culture of biomedicine has its own set of interests, emotions, biases, so how can you expect to deal successfully with someone else’s culture? (Fadiman, 2007, p. 261).” This resonated with me and really emphasized the need for proper education and understanding of cross-cultural issues and

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Neil Ernst and Peggy Philp were the two supervising pediatricians for Lia and no matter how frustrating the situation got, they would never see themselves abandoning the case. Neil admits he thought it was important for the Hmong community to understand that “there were certain elements of medicine that we understood better than they did” and it was “necessary that they followed” (78). So he decided to send a nurse to the Lee home to try to improve the family's compliance with Lia’s medication

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“The Spirit Catches You and You Fall Down” by Anna Fadiman tells the story of Lia Lee, a Hmong child with epilepsy, whose life could have been different if only her family was caught up in western medicine. This book reveals the tragic struggles between a doctor and patient because of lack of communication. When Lia was around three months old, her older sister Yer accidentally slammed a door and Lia had suddenly fallen into the floor. This is the first recorded time that Lia was experiencing an epileptic shock.

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It wasn’t until a couple of seizures later that the hospital understood that that the baby was suffering from seizures. Lia was to begin a strict regime of medication which was to limit the number of seizures. Because the Lee’s did not fully understand the medication and saw the epileptic seizures as part of the divine, the Lee’s did not stick to the medication as prescribed. What follows are a series of seizures, hospitalizations,

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Many of the Hmong (including the Lee family) immigrated from their Thai refugee camp to America in the late seventies. The book is mainly about the Hmong culture and healing beliefs colliding with “modern” American medicine. The Lees want to heal Lia spiritually with a Txiv neeb (spiritual healer), and don’t really want to use and medicine provided by their doctors. At the beginning of the book Fadiman explains why the Hmong prefer a Txiv neeb over a doctor. She writes, “Txiv neebs were polite and never needed to ask questions; doctors asked many rude and intimate questions...

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In the documentary, “The Split Horn: Life of a Hmong Shaman in America,” portrays the journey of an immigrant Hmong family battling to maintain their cultural traditions alive in the United States. In the Hmong culture, it is believed that every individual has seven souls and if they have an illness, for example sickness, it means that their soul has departed or taken by evil spirits. Hmong people believe in Shamans, who are gifted and respected people who can make contact with their ancestors and return the lost souls of people. In this documentary, the main character Paja Thao is a shaman who is challenged by American customs to keep his cultural Hmong traditions alive and pass it down to his children. Paja becomes sick because he feels like his children don’t care about the Hmong tradition anymore because they don’t participate in his rituals and realizes his children have assimilated to the American culture.

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Within the Hmong culture there is great emphasis on symmetry, balance, and complementary sections in bodies, society, and cosmos. Additionally, the soul must be kept in balance to maintain good health; sadly, the soul of Lia was not kept in good health which lead to severe, poorly-treated epilepsy. The medical mistakes and lack of precise communication ultimately lead to an untimely death of Lia; however, between both parties dealing with Lia’s epilepsy, the severity of her illness could have been prevented if both parties took Eliade’s perspective on sacred space into account during treatment. Sacred space, in terms of Eliade’s perspective, is one of the most critical, cherished topics that defines his paradigmatic model for religion. The

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“Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (Fadiman 21). Known as the quag dab peg ‘when you fall the spirit catches you’ are said to be the “most treasured possessions a person can have” (Fadiman 22). Which was considered to be a calling to become a host of a healing spirit. The author kept up to date through Lee’s tragic experience with translation complications, inequality and culture shock. Little did she know that she would be witnessing a “collision” as one doctor called it.

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I feel that this led to the Ernst’s becoming fed up and “burnt out” on helping them and eventually resulted in lack of care for Lia. This relates to what Brown said in her article about doctors becoming burnt out and how it could hurt patients as well. The doctors rarely attempted to understand or relate to the Hmong culture of medicine and they viewed the Lee’s as stubborn and ignorant. One doctor even went to the extent of saying that the easiest way to treat a Hmong patient was with a bullet to the head, hence the name of chapter 6 “High-velocity transcortical lead therapy.” From the Lee’s perspective, they thought the traditional Hmong worldview was the only way to approach life.

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Rather than presenting the reader with Lia’s medical history and condition right at the beginning, Fadiman retraces her steps, like the Hmong presenter, by starting with the birth of Lia. The first sentence states, “If

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Over the progression of the book the view points and relationships between the Lees and the doctors develops slightly. The medical staff was not prepared with a translator or a cultural understanding of the Hmong and how their beliefs would not match up with their medical practices. “Not only do the Hmong fail resoundingly to improve the payer mix- more than eighty percent are on Medi-Cal- but they have proved even more costly than other indigent patients, because they generally require more time and attention, and because there are so many of them that MCMC has to hire bilingual staff members to mediate between patients and providers” (Fadiman 25). This theme in the story was immensely eye opening for all of the cultural gaps that exist throughout the United States. The solution to this problem is for both sides standing on opposite sides of the gap to take the time to bridge the gap together.

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The book represents the Hmong and western medicine as being static. Throughout the book the Hmong are depicted as being very hard headed and not willing to adapt. It however also shows mainstream western medicine being just as stubborn to change. Historically the Hmong have faced many challenges, from being used by the American Army as cheap labour and soldiers to becoming refugees but they never gave up their cultural beliefs (Fadiman 1997). A specific example of this can be seen she talks about the tensions the Hmong faced in China, and how the Chinese government tried to change the Hmong community, and make them wear Chinese clothing, cut their hair short etc, however the Hmong responded to this by first fighting and eventually migrating(Fadiman 1997:16).

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This strong belief against only using medical help was heightened by the doctors frustration towards the Lee family for not following instructions, as well as the difference in perspectives of seeing Lia’s condition as special, the Lee family feeling as if Lia was “like a member of royalty” (Fadiman, 1997, p.22) due to her condition, and the doctors stubbornness to treat it with a multitude of medications with negative side effects. Unfortunately, the combination of not understanding the medication application, as well as conflicting culture beliefs, lead the doctors to think the Lee family was not complying with them, and felt “Lia’s parents were endangering her health” (Fadiman, 1997, p.79) which lead them to contact child services. This process of taking away Lia, which only worsened her condition, could have been handled more appropriately if the doctors had underwent enculturation, being defined as “the process of learning behaviors, languages, beliefs, and roles common to ones first or home cultures” (Barrera et al., 2012 p. xx), this allowing the doctors to not think poorly of the Lia’s parent’s but instead understanding of the cultural beliefs and reasons for them. However, it would be unfair to state the doctors didn’t give the Lee’s the benefit of the doubt, Fadiman (1997) stating that Neil, one of Lia’s doctors, “postponed calling Child Protective Services for as long as he could, giving Lia’s parents every possible chance to reform, talking the case over with his wife every night” (Fadiman, 1997, p.79) and only reported the family under the true impression that he was doing what was in the best interest of

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