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The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

4.12 of 5 stars 4.12  ·  rating details  ·  36,551 ratings  ·  3,256 reviews
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 dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy ...more
Paperback, 341 pages
Published September 28th 1998 by Farrar, Straus and Giroux (first published 1997)
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Best Non-Fiction (non biography)
53rd out of 3,214 books — 5,193 voters
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Medicine and Literature
11th out of 1,012 books — 1,266 voters


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Community Reviews

(showing 1-30 of 3,000)
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Inder
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'.

Don't read any further unless you don't mind knowing the basic story told in this book (there are no spoilers, since this is not a book with a surprise ending, but if you want to keep a completely open mind, stop now) ...

I have wavered between four and five stars for this on
...more
Lisa Vegan
Oct 13, 2007 Lisa Vegan rated it 5 of 5 stars
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 culture ...more
Teresa
Jul 27, 2012 Teresa rated it 4 of 5 stars  ·  review of another edition
Recommended to Teresa by: rhea
A book like this one should be required reading for anyone who lives in a community of multicultural members, and nowadays that's probably just about everyone. Sadly, and not surprisingly, those who would probably most benefit from a book like this would probably be the ones least likely to read it.

It's an eye-opener on cross-cultural issues, especially those in the medical field, but also in the religious, as the Hmong don't distinguish between the two. In understandable and compelling language
...more
Eric
Jul 12, 2007 Eric rated it 5 of 5 stars
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 is in how to
...more
Hamad
May 12, 2008 Hamad rated it 3 of 5 stars
Recommends it for: Medical students, anthropologists
Recommended to Hamad by: Academic
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 dimensio ...more
Mmars
There are so many valuable aspects to this book it's hard to decide what to mention. Having just learned that Lia, the subject of the book, passed away within the last week I'd like to express sheer admiration to her family, and especially her parents, for loving and caring for her for so many years.

Along with a large influx of Hmong, Lia lived in Merced, CA when she experienced her first seizures. The Hmong and their language and their culture were yet virtually unknown and entirely misunderst
...more
Crawford
Aug 14, 2010 Crawford marked it as to-read
Shelves: recommended
Educational warning: This book will teach you something important about non-compliant patients.


The title of The Spirit Catches You and You Fall Down is the literal translation of the Hmong words for epilepsy. All doctors know about epilepsy; virtually none know about the Hmong people. They are an ethnic group who lived in China for hundreds of years.

The Hmong have often been thought of as "outsiders." Over the centuries they have resisted taming by various domineering governments and oppressors.
...more
Heather
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
Robbin
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, ...more
Samantha Newman
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 be sooo different. It's
...more
Chelsea
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 points out that
...more
Merritt
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 learned ...more
Sarah
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
K
Nov 19, 2008 K rated it 5 of 5 stars
Recommends it for: everyone, but especially book clubs, religious people, and medical personnel
"The Spirit Catches You and You Fall Down" explores the tragedy of Lia Lee, a Hmong child with epilepsy who eventually suffered severe brain damage, from a variety of perspectives. One perspective is that of her family, who believed that epilepsy had a spiritual rather than a medical explanation, and who had both practical difficulty (as illiterate, non-English speaking immigrants to the U.S.) and general reluctance to comply with Lia's complicated medical regimen. Another perspective is that of ...more
Irene
"The parents of one small boy emptied his intravenous bottle refilling it with a green slime of undetermined ingredients- herbal home brew made by the Hmong parents for ages. Hmong patients made a lot of noise in the hospital which annoyed their American counterparts. They sometimes wanted to slaughter animals in the parking lot or hospital room of a sick relative. One resident recalls" they would bang the crap out of some musical instrument while visiting sick relations and the American patient ...more
Naeem
So close and yet so far.

Fadiman sets up an epistemological encounters between US doctors and Hmong culture. The life of a young woman is at stake.

The book is well written, well researched, and Fadiman's heart seems to be in the right place.

The book fails however. Ultimately, as hard as she tries, Fadiman cannot overcome her biases. That would be less of a problem if she did not want to come across as "objective."

A touch of theory and a bit of world history might have been enough to take Fadima
...more
El
A little Hmong girl slammed the front door once and her three month old sister had what the medical community call an epileptic seizure. The Hmong family referred to it as quag dab peg which translates to "the spirit catches you and you fall down". It was the beginning of a long series of similar seizures, and the beginning of a long series of difficulties between the Hmong and American cultures.

Lia Lee and her family were refugees living in Merced, CA when the spirit first caught Lia in this wa
...more
Chrissie
Apr 12, 2012 Chrissie rated it 4 of 5 stars
Recommended to Chrissie by: Lynne
Having now finished the book, I know Lia's fate. You must read the book to find out. No spoilers here!

It is important to note that this book should be read by those not only interested in anthropology and how medical practices could/should be improved, but also those wanting to learn more about the Silent War in Laos. So many have been written about the war in Vietnam and so few about that in Laos.

How do you teach doctors to feel empathy and love for their patients? Physical contact is one quick
...more
Miklos
Is it terrible that I found myself sympathizing with the doctors and that the family was getting in the way of treating their childs illness?
Elizabeth
Oh I loved this book on so many levels! The book cover captures the basic thread “A Hmong Child, Her American Doctors, and the Collision of Two Cultures.” I picked the book recently after reading of the death of a major character. I just can’t believe I haven’t read it earlier.

At the most basic level, it is a story about clashing cultures, but it is so much more. I live in a metro area with one of the largest populations of Hmong outside of Asia, yet I didn’t realize how little I knew about the
...more
smetchie
If you like non-fiction just ignore my lack of stars. This is a really interesting story, well told. I learned all kinds of stuff. It made me mad when the author wanted me to be mad and it made me sad when she wanted me to be sad. She exposed the massive cultural divide between Hmong and Western medicine while telling a sweet and heartbreaking story. She made me think and explore my own cultural bias. The topic is extremely thought-provoking. It's all there. I expect most everyone would enjoy th ...more
Emily
The Spirit Catches You and You Fall Down is an engaging and thoughtful look at the role culture plays in medicine. This is a true account of doctors trying to care for their patient and a family trying to cope with a foreign culture, with Lia, a girl with a severe seizure disorder, caught in the middle. Everything that could go wrong does, and each side has their own views of the causes and consequences. Fadiman tends to side with the Hmong, which is understandable. They are clearly the underdog ...more
Chana
This is a very serious book filled with history, medical information, Hmong culture and the politics of war and immigration in the United States. It is a rather damning text, both to the U.S. in our international politics, and to the rigidity of our medical system.
Lia Lee is the 13th child of a Hmong couple from Laos. When the communists are victorious in Laos the Hmong people were killed, tortured, starved for their part in the war which was fighting on the U.S. side. So Lia's parents (Lia was
...more
Jerzy
A very thought-provoking, useful read for anyone working in a cross-cultural setting, not just health care. The assumptions that a Westerner takes for granted (e.g. your doctor knows what medications to prescribe, and you endanger yourself if you don't take the full dose) may be quite contrary to other peoples' beliefs (e.g. a Hmong parent is making an eminently reasonable compromise by giving their child a little of the Western medications and a little of their own spiritual healing, instead of ...more
Stephanie
Jun 18, 2009 Stephanie rated it 4 of 5 stars
Recommended to Stephanie by: Nikki's Book Club
It’s tempting to think that everyone in the world thinks pretty much like we do – people are people, after all – particularly if they live here in the United States and especially if they dress like us. A little careful reading, however, can show us just how wrong that assumption is. In The Caliph’s House , author and protagonist Tahir Shah bumbles his way through Moroccan society with hysterical results. Anne Fadiman’s The Spirit Catches You and You Fall Down also examines what happens when cu ...more
Maia B.
It's terribly difficult for the family - any family - of a severely epileptic child to deal with the situation. Imagine it: not knowing when the seizures would start, not sure whether the medicine was helping or hurting, seeing the doctors without another route to take when it's clear what they've been doing isn't working. It's awful.

Now imagine that you can't speak any English at all, you spent 90% of your life living in a tiny east-Asian country and only moved to the U.S. a few months ago, and
...more
Kurt
This book is amazing. Heartbreaking, informative, honest, intense... Fadiman presents a case study of Lia Lee, a young Hmong girl who suffers from seizures. The case study is emotionally gripping from the start - Fadiman is an expert at weaving together narratives from a variety of eyewitness accounts, and it is clear from their tone that Fadiman is presenting what may be the most poetic autopsy in history. Clearly, Lia's condition is going to get worse, and clearly, there will be a literary inv ...more
Spencer
The three stars is actually closer to four but I don't think it quite deserved four. While very informative, I found the dreadfully long historical chapters took away from the book. The book was, however, an excellent look into the struggles of vastly different cultures in a patient-doctor scenario. I found myself extremely annoyed and frustrated with the Hmong and yet it was difficult for me to truely hate or be mad at them because they did everything to the best of their knowledge to help Lia. ...more
Shane Jaynes
One of the themes that recurred throughout Fadiman's telling of this tragic turn of events is how the Hmong people and various iterations of American culture(medicine to be sure, but also the public assistance, child protection, etc.) see one another ethnocentrically. She memorably describes this as each party turning the other's "gold into dross." I was pleased at this even-handed assessment. It made me reflect on the fallability we carry as individuals and the need for humilty and curiosity ab ...more
Jenna
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 that science ...more
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Schumpp, EII Hono...: The Spirit Catches You and You Fall Down 1 1 Apr 29, 2014 08:45AM  
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Anne Fadiman, the daughter of Annalee Whitmore Jacoby Fadiman, a screenwriter and foreign correspondent, and Clifton Fadiman, an essayist and critic, was born in New York City in 1953. She graduated in 1975 from Harvard College, where she began her writing career as the undergraduate columnist at Harvard Magazine. For many years, she was a writer and columnist for Life, and later an Editor-at-Larg ...more
More about Anne Fadiman...
Ex Libris: Confessions of a Common Reader At Large and at Small: Familiar Essays Rereadings: Seventeen writers revisit books they love The Best American Essays 2003 The Spirit Catches You When You Fall Down

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