The Spirit Catches You and You Fall Down

by Anne Fadiman

book data

7,088 ratings, 4.15 average rating, 1,279 reviews (more data...)

rating	frequency	%
5		39%
4		39%
3		16%
2		3%
1		0%

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published

September 28th 1998 (first published 1997) by Farrar, Straus and Giroux

binding

Paperback, 352 pages

literary awards

National Book Critics Circle Award (1997)

isbn

0374525641 (isbn13: 9780374525644)

description

Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain...more

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08/03/07

Inder rated it:

(review of isbn 0374267812)

bookshelves: california, culture, disease, ethnography, health, history, law, read-2007

Read in September, 2007

This is the heartbreaking story of Lia, a Hmong girl with epilepsy in Merced. It is intended to be an ethnography, describing two different cultural approaches to Lia's sickness: her Hmong parents' and her American doctors'.

I have wavered between four and five stars for this one. The book is so beautifully and compassionately written - you feel for absolutely everyone in the story. Like Lia's doctors, you can't help but feel frustrated with Lia's noncompliant, difficult, and stubborn...more

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06/24/07

Lisa Vegan rated it:

bookshelves: biography, bookclub, non-fiction, reviewed

Read in October, 2007

recommends it for: anyone who has interest in understanding people different from them

I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well. Not that I didn’t feel angry (and amused) at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman’s account of the events. My c...more

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02/04/08

Bobbi rated it:

Read in February, 2008

Wow.

I loved this book.

I learned a lot, and the story is compelling and well-told. The Spirit Catches You and You Fall Down is the story of Lia Lee, a Hmong girl living in Merced, California, who began to have epileptic seizures as an infant. Her parents, recent immigrants, did not speak English and their complex relationship with the staff of the local hospital -- and the snowballing ramifications of that cultural disconnect -- form the basis for this book. This book ...more Wow.

I loved this book.

I learned a lot, and the story is compelling and well-told. The Spirit Catches You and You Fall Down is the story of Lia Lee, a Hmong girl living in Merced, California, who began to have epileptic seizures as an infant. Her parents, recent immigrants, did not speak English and their complex relationship with the staff of the local hospital -- and the snowballing ramifications of that cultural disconnect -- form the basis for this book. This book is part cultural anthropology, part human drama, part history lesson (call me stupid, but prior to reading this book I didn't know squat about the Hmong, a fascinating people without a country who have been an unassimilated minority in China, Laos, Thailand and the United States).

The author, Anne Fadiman, is an amazing researcher with a strong voice and an interesteing story to tell. If I have one criticism of her writing, it would be that she does occasionally allow her intellectual-media-left-leaning-elite biases to show through (she seems appalled by cultures with high birth rates and she is amazingly understanding and respectful of everyone except some "fundamentalist Christian" neighbors, to whom she repeatedly refers disparagingly, and I couldn't help but wonder if she would have hailed them as visionaries if only they had invited a shaman into their apartment to slaughter a pig, but I digress...), but overall I give her high marks for equanimity as she describes the Hmong culture and history to an American audience and places it into multiple contexts. She makes sense of customs that are more than foreign to most of us (pottying in the forest, eating a mix of entrails that is fondly called "doodoo soup," and inviting the shaman and the extended family into intensive care units, to name a few), and managed to keep my interest while veering between Lia Lee's medical case (her records were over a foot high) to the role of the Hmong in the Vietnam war to descriptions of their impact on communities such as Merced.

Given the fact that, as Anne Fadiman points out, half of the U.S. population growth since 1990 has come from immigrants and their children, this real-life cautionary tale is relevant to all of us. I find myself curious about how things worked out for the Lee family after the story ended.

I recommend this book highly, and I want to read everything that Anne Fadiman writes.

**After reading several other reviews, I am struck by the ignorant commentary on how bad America is, how arrogant our culture is, how Western medicine sucks, etc. In addition to missing the point of the book, these comments are just plain wrong. I have yet to experience a cultures that is LESS arrogant -- or more inclusive -- than American culture is, and my experience of other cultures is at least a little broader than average. Both in terms of geography and in terms of history, these criticisms are way off the mark and belie an intellectual laziness, to say the least. It's fashionable to say such stupid things, but some folks need to get out a bit more.(less)

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02/18/08

Hamad rated it:

Read in May, 2008

recommended to Hamad by: Academic
recommends it for: Medical students, anthropologists

The Spirit Catches You And You Fall Down may read like a documentary (thanks to Fadiman’s journalistic background), but it is really an introspection on the western system of medicine and science. We cannot ourselves metaphorically stand back and try to look at the system from the outside. However, comparing it to another (supposedly antithetical) system through the experiences of the Hmong refugees can be used as a tool to do just that. The Hmong’s presumed non-separation of any of the dim...more The Spirit Catches You And You Fall Down may read like a documentary (thanks to Fadiman’s journalistic background), but it is really an introspection on the western system of medicine and science. We cannot ourselves metaphorically stand back and try to look at the system from the outside. However, comparing it to another (supposedly antithetical) system through the experiences of the Hmong refugees can be used as a tool to do just that. The Hmong’s presumed non-separation of any of the dimensions of life (least of all the physical) is a good contrast to the western notion of categorization and separation of the physical, emotional, spiritual and mental. This categorization is a manifestation of the desire for control – labeling and naming are just the initial objectives of this desire. In contrast, the Hmong view control quite differently. Given such vast differences on such fundamental aspects, one wonders if the result could have turned out another way at all.

Categorization and classification is the ‘bread-and-butter’ of science. It is supposed to be ‘rational’ and evidence-based. Western medicine seems to not only classify problems into different aspects of the overall human – physical, mental, emotional and spiritual, it tends to also over-categorize – different physicians for different organs or diseases, specialization etc. On the other hand, according to Fadiman, the Hmong don’t even bother with the separation of these different aspects; they do not even have a concept of ‘organs’ making up a human body. There is definitely no separation between the physical and the spiritual. Fadiman’s observation of the Hmong obsession with American medicine and the behavior and attitudes of American doctors delineates this point clearly. This lack of categorization also goes beyond the individual and is reflected by a relatively classless structure of Hmong society: Fadiman points out that the Hmong do not separate themselves by class, and live by a more egalitarian standard.

The need to classify and categorize stems from a desire to control. By classifying organisms into different species, genus or families, we try to exert control over nature. By categorizing people according to gender, class and race we try to assign people different roles and duties, further illustrating society’s desire to control individual lives - to maintain ‘order’. This desire is more so present in medicine, where we explicitly try to control disease, pain, suffering and eventually life (or death). Since the Hmong concepts of separation are close to non-existent, their view is that of ‘letting go’. Fadiman observes how holistic their approach is compared to the approach of the American physicians by showing that even though the Lees cared a great deal for Lia (and loved her unconditionally), they still tried to persuade the spirit to let go of Lia’s soul so it would come back to her. The American doctors, however, got progressively invasive trying, in vain, to assert more control over the situation by intubating, restraining and over-prescribing.

Given this discordance in the fundamentals of each culture’s worldview, the question that begs to be answered is: could things have gone differently? The Lees at one point acceded that they would be willing to use a combination of therapies both from their culture and their recently adopted culture, but would the physicians have complied to it as well? Given the history of discrimination in this country, would it be wise to go back to ‘separate but equal’? These are only some of the questions that arise from the book. There may be fundamental differences between two cultures, but could there also be fundamental similarities? (less)

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02/25/08

Robbin rated it:

Read in February, 2008

i read this book for a class i am taking called "human behavior and the social environment." it tells the story of a Hmong family in california with a little girl who has epilepsy. their experience as refugees who are illiterate and unable to speak english, traversing the american medical system ends up tragic. however, the author is really good at giving voice to both sides, the western doctors (impatient, overworked, stubborn, judgmental, dedicated) and the Hmong family (impatient, o...more i read this book for a class i am taking called "human behavior and the social environment." it tells the story of a Hmong family in california with a little girl who has epilepsy. their experience as refugees who are illiterate and unable to speak english, traversing the american medical system ends up tragic. however, the author is really good at giving voice to both sides, the western doctors (impatient, overworked, stubborn, judgmental, dedicated) and the Hmong family (impatient, overworked, stubborn, judgmental, loving). at their wit's end the doctors have the little girl removed from the home and placed into foster care. the foster family not only falls in love with lia (the epileptic toddler) but they fall in love with the family. perhaps, the first and only time in history the foster mother even allows the so-called abusive mother baby-sit her OWN children while she takes lia to one of her appointments. through a series of events lia ends up in a vegetative state (and at that point her epilepsy in her brain dead state is actually cured), and she is returned home to die. but she doesn't. the Hmong family keeps her alive with their love and care, something the doctors had never witnessed. on their own terms, they continue to feed her, bathe her, and watch over her literally 24 hours a day (she sleeps in the bed with the mother every night). she continues to grow with rosy skin and healthy hair, and the Hmong family continues to believe that the western doctors and their medicine actually made her seizures and illness worse. anyone going into the medical/social work/psychology field should read this book.

what could be lost in the story is the background the author gives to the story of the Hmong, a culture and people that have been continuously marginalized and persecuted in every society they have lived in. nomadic to escape assimilation, they remain a strong and loyal group of people with a complex system of justice and care. they also fight the US government's "secret war" against the communists and bare the brunt of the CIA's unsuccessful agenda. (less)

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11/26/07

Chelsea rated it:

bookshelves: 2008, non-fiction, socialcommentary

Read in February, 2008

Fadiman wrote a fascinating and sympathetic story about a culture that couldn't be much farther removed from ours in the West. It was especially interesting reading it right after Hitchen's God Is Not Great, because, theoretically, had there been no religion involved there wouldn't have been a real culture clash, and Lia could have grown up as an epileptic but functioning girl. Maybe.

But that's not really the point of Fadiman's book: she doesn't condemn anyone, and, in fact, she po...more

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09/30/07

Samantha rated it:

bookshelves: nonfiction

Read in September, 2007

I never would have chosen this book to read on my own. So I must thank Eliza for lending it to me. (I now feel like lending/recommending a book proves friendship...)

I didn't know anything about Hmong culture and now I do. This book also taught me about the American medical system - it looks strange when you step back.

It would have been a good book for me to read when I was in Japan, too, because it kind of opened me up to the idea that people of other cultures can really...more

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08/16/07

Ngoc rated it:

bookshelves: schooldays

Read in January, 2002

This book is sooo good! I especially like the story of Lina and her family and their struggles. I think the book could have been shorter if they didn't go into so much depth about the interworkings of the social service and medical systems. Yes it's messed up and cultural competency is lacking. I liked that it gave enough information to show how the family was treated injustly and Lina couldn't get the medical treatment she needed because the doctors and parents weren't communicating. They all w...more

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03/12/09

Hana rated it:

Read in September, 2008

What a fantastic book. This fascinating work of medical anthropology recounts the story (really more of an odyssey) of Lia Lee, the daughter of Hmong refugees who immigrated from Laos to Merced, California. Lia is afflicted with what her doctors diagnose as severe epilepsy and her parents call quag dab peg, or “the spirit catches you and you fall down.” Over the years, as Lia’s condition worsens, her parents and doctors blame one another and themselves. Fadiman masterfully balances the cla...more What a fantastic book. This fascinating work of medical anthropology recounts the story (really more of an odyssey) of Lia Lee, the daughter of Hmong refugees who immigrated from Laos to Merced, California. Lia is afflicted with what her doctors diagnose as severe epilepsy and her parents call quag dab peg, or “the spirit catches you and you fall down.” Over the years, as Lia’s condition worsens, her parents and doctors blame one another and themselves. Fadiman masterfully balances the clashing perspectives of Lia’s family and her American doctors, who are deeply caring, empathetic, and generally very competent, but can sometimes be ignorant or misguided when it comes to Lia's medical treatment(s).

Fadiman also widens her book’s scope to encompass a study of Hmong culture and traditions; an examination of Western medicine; and the history of U.S. involvement in Laos, which forced thousands of Hmong to leave their homes and, in many cases, flee to the United States. Considering that Fadiman is an American - and ethnically Caucasian, at that - her discussion and analysis of Hmong vs. U.S. medical practices and attitudes toward illnesses like epilepsy were remarkably astute. I also appreciated the background she gave on the fraught backstory (and even current relations) between Laos and the U.S. thanks to the "Quiet War." "Quiet" indeed - I'd never even heard of it before reading this book, and I pride myself on being generally well-versed in Asian history. I guess I'm more familiar with East Asia, though. I knew almost nothing about Laos.

It makes me think of something David Sedaris wrote in "See You Again Yesterday," an essay/short story from his hilarious nonfiction collection, Me Talk Pretty One Day:

"As an American abroad, you're bolstered by an innate sense of security. Something goes wrong, and you instinctively think, 'We'll just call the embassy and see what they have to say.' People know where America is on the map. They know that it's loud and powerful. With certain other countries there's no such guarantee. 'Oh, right, Laos,' I once heard someone say to a dinner guest. 'Didn't we bomb you a couple of times?'" (Sedaris 162-3).

It's not fair or right, but it is true.

Epilepsy is an illness that continues to baffle medical professionals and affects more than 3 million people in this country and 50 million worldwide, according to the Epilepsy Foundation (http://www.epilepsyfoundation.org/about/...). Yet there is little public awareness of epilepsy and scarce funding for epilepsy research. Several family members (my grandfather, uncle, and cousin) have suffered from the disease, and my mother, a doctor and scientist, specializes in epilepsy. She was the reason I volunteered at Wee Kan Tu, a summer camp for children with epilepsy, when I was 16, and in the epilepsy center of Children’s Memorial Hospital this past January (I now volunteer at Heartlight). Epilepsy deserves its turn in the spotlight, and I hope that now that the Axelrods are in high places, it will get more publicity. The family has already been interviewed by a couple of media outlets about their daughter, Lauren, who has idiopathic epilepsy, at one time thought to be intractable. Parade did a great article profiling Susan and Lauren Axelrod (http://www.parade.com/health/2009/02/sus... OR http://tinyurl.com/brrwbx). I am pretty passionate about raising epilepsy awareness. I am currently developing a podcast about epilepsy, though it will take a while for that to come to fruition...just like my blog.
(less)

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01/31/09

Heather rated it:

Read in August, 2008

Anne Fadiman addresses a number of difficult topics in her depiction of a Hmong couple's quest to restore the soul to their child. While I consider myself a culturally sensitive individual, having been raised in a family of doctors and nurses, I have long held the conviction that the world's best doctors (whether imported or native) tread on American soil. Reading Fadiman's account (which sometimes includes actual excerpts from the patient's charts), I was forced to take a hard look at my assump...more Anne Fadiman addresses a number of difficult topics in her depiction of a Hmong couple's quest to restore the soul to their child. While I consider myself a culturally sensitive individual, having been raised in a family of doctors and nurses, I have long held the conviction that the world's best doctors (whether imported or native) tread on American soil. Reading Fadiman's account (which sometimes includes actual excerpts from the patient's charts), I was forced to take a hard look at my assumptions. In the course of reading this book, I have redefined my idea of what constitutes a good doctor.

Fadiman spent hundreds of hours interviewing doctors, social workers, members of the Hmong community--anyone who was somehow involved in Lia Lee's medical nightmare. She pored over years of medical records, trying to make sense of the events that caused a spirited, loving toddler to slowly devolve into a vegetative state. What she found was that the doctors' orders, prescribed medications, hospital care, etc., were all based on a number of Western assumptions that did not take the family's (and child's) best interests into consideration. No attempt was made to understand how the family saw the disease or what efforts they were making on their own to address the situation. More than a translator, what doctors and other professionals involved in Lia's case needed was a "cultural broker" who could have stepped in and possibly saved Lia's brain from further deterioration.

Fadiman's book is a difficult read, not because of specialized vocabulary or lofty philosophical concepts, but because there comes a point when the reader realizes that the barriers faced by those involved were much more cultural than they were linguistic. In a very real way, the Lees inhabited a different world than the doctors, and vice-versa. Each assumed that their way was best, and neither made a genuine effort to understand the other's motivations, much less their logic. In the end, there was no simple solution to their plight, but more mutual respect and understanding of the differences between the cultures would have benefitted everyone involved.

If there is a moral to Fadiman's work, it may be this: The best doctors are not those who know the most, but rather those who admit what they do not know, and try to understand the full picture. Good doctors may treat the disease, but the best doctors treat the individual. (less)

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01/21/09

Sarah Pi rated it:

bookshelves: brains, non-fiction

Read in April, 2009

Amazing book. In my work with people with developmental disabilities and epilepsy, I've seen a lot of examples of the disconnect between doctor and patient -- and that's even when both speak a common language and have a common cultural understanding of their roles. This book tells the story of an extreme example, in which the patient's parents neither understood the doctors nor trusted them, and the medical system held a reciprocal inability to understand where the family was coming from. In tel...more

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12/29/08

Liz rated it:

Read in December, 2008

This is a fabulous book. I read it several years ago when we were beginning to learn about the Hmong people coming to California and to our schools. I reread it last week after reading Fieldwork (and finding out the the tribe of people he writes about is made up) in order to get a better sense of what people from the hill tribes in Southeast Asia believe, think, and experience. In the case of this book, those thoughts and experiences are in direct conflict with the new country of residence fo...more

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10/22/08

Kara rated it:

bookshelves: nonfiction

Read in October, 2008

This book is a nonfiction look at the Hmong people, a Laotian ethnic group many of whom have come to the U.S. as refugees in the decades after they supported the U.S. against the communists in Laos, and the roots and impacts of the cultural misunderstandings that have inevitably arisen between the Hmong and America. A book club favorite, I believe (which is, of course, why I read it).

It alternates between chapters covering cultural history of the Hmong and chapters that focus on the...more

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11/26/07

Reid Mortimer rated it:

Read in November, 2007

recommends it for: Everyone!

Born in 1981, Lia Lee was the daughter of Hmong immigrants new to the United States, who knew little English and little understanding of American culture. Soon after she was born, Lia starts having seizures that are soon diagnosed as epilepsy.
The book is the story of Lia’s life, and the battle to keep her alive. Her parents, with their own strong Hmong cultural beliefs, credited Lia’s seizures to an incident that happened right before her first seizure, when her older sister slam...more

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09/10/07

Jenna rated it:

Read in January, 2007

Extraordinarily well-researched nonfiction book whose author earnestly sought to understand how a medical tragedy involving a young Hmong girl came to take place. The chapter about the involvement of the Hmong people in the Vietnam War should be required reading for all Americans, if only because we shouldn't forget how much we owe these people or what far-reaching ramifications a short-sighted foreign policy can have. Like "Mountains Beyond Mountains," this book makes the argument t...more

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09/02/07

Merritt rated it:

bookshelves: memoirs

Read in January, 2006

An interesting story that highlights the many cultural differences between Americans and our immigrants (in this case the Hmong culture). Lia Lee is a Hmong child with severe epilepsy and the American doctors trying to treat her clash over her entire life with her parents, who are also trying to treat her condition. Fadiman walks a fine line in describing the story fairly from both perspectives; however, it's difficult, as an American, to not feel some anger toward this girl's family. I learn...more

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11/05/07

Anne rated it:

Read in December, 2007

Every once in awhile I start reading a book and I just want to rush out and tell everyone about it. This is one of those books. This is the story of Lia Lee, a newborn Hmong girl living in Merced, California with her parents and seven siblings. Her parents speak no English, and when Lia begins suffering from epilleptic seizures, they reluctantly take her to the nearby hospital. From there, this book chronicles the vast cultural differences between mainstream Americans and the Hmong, and how lang...more

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01/29/09

OneWorldLibrary Project rated it:

bookshelves: adult, colliding-cultures, hmong, medicine, nonfiction, spirituality

�Lesley Wright (Bristol): This may be the most popular book in the Literature and Medicine program sponsored by the Vermont Humanities Council. Health care professionals who participated found the story of this Hmong family's clash with the medical profession both powerful and wrenching. Fadiman's role as "cultural broker" is remarkable, helping both parties bridge two very different world views and, in doing so, raising the bar for those of us dealing with our own cultural divides. Th...more

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07/12/07

Eric rated it:

recommends it for: human nature considerers, foreign culture sponges

This is one of the best books I've read. I guess it would be considered part of the medical anthropology genre, but it's so compelling that it sheds that very dry, nerdly-sounding label. This was recommended to me in a cultural literacy course and it certainly delivered.

The story is of the treatment of the epileptic child of a Hmong immigrant family in the American health system. The issue is the clash of cultures and the confusing and heartbreaking results. And the takeaway lesson ...more

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08/04/07

Ann rated it:

bookshelves: medicine

Read in January, 2009

The Spirit Catches You and You Fall Down is the clash between western medicine and Hmong ritual healing as played out in the care of Lia Lee, a child with epilepsy. Author Anne Fadiman does an incredible job explaining the conflict, because I felt great frustration and great compassion for both the Lee family and the doctors, in succession as the story unfolded. The cultural barrier was often more insurmountable than the language barrier in trying to find common ground between the two worlds. ...more

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