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

by Anne Fadiman

Lia Lee was born in 1982 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 of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty—and their nobility.

Genres: Nonfiction, Medicine, Anthropology, Medical, Science, History, Memoir

341 pages, Paperback

First published January 1, 1997

About the author

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-Large at Civilization. She has won National Magazine Awards for both Reporting (1987) and Essays (2003), as well as a National Book Critics Circle Award for The Spirit Catches You and You Fall Down. Ex Libris: Confessions of a Common Reader, a collection of first-person essays on books and reading, was published by Farrar, Straus and Giroux in 1998. Fadiman was the editor of the intellectual and cultural quarterly The American Scholar from 1997 to 2004. She now holds the Francis chair in nonfiction writing at Yale. Fadiman lives in western Massachusetts with her husband, the writer George Howe Colt, and their two children.

http://us.macmillan.com/author/annefa...

Reviews

[Matt · Rating 5 out of 5]

“When Lia was about three months old, her older sister Yer slammed the front door of the Lees’ apartment. A few moments later, Lia’s eyes rolled up, her arms jerked over her head, and she fainted. The Lees had little doubt what had happened. Despite the careful installation of Lia’s soul during the hu plig ceremony, 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”…On the one hand, it is acknowledged to be a serious and potentially dangerous condition…On the other hand, the Hmong consider quag dab peg to be an illness of some distinction.”
- Anne Fadiman, The Spirit Catches You and You Fall Down

If nothing else can be said about this book, it should be said that it will cause a reaction. Most books are a monologue. The author is telling you something and you listen. Anne Fadiman’s book is so engaging, and touches on so many sensitive subjects, that it’s more like a dialogue between author and reader. And I use the word dialogue literally. During the course of this book, I found myself audibly voicing my opinions at the page like a crazy person. My wife would ask me what I was saying, and I’d tell her “I’m not talking to you I’m talking to the book!” Sometimes I agreed with Fadiman. Sometimes I didn't. In any event, I was locked in, totally absorbed.

The Spirit Catches You and You Fall Down is a sad, beautiful, complicated story that is ostensibly about a tragedy that arose from a clash of cultures, but is really about the tragedy of human beings.

Lia Lee was three months old when she suffered her first epileptic seizure. Her parents, Nao Kao and Foua, were Hmong refugees from Laos who didn't speak any English. They took Lia to Merced Community Medical Center, a county hospital that just happened to boast a nationally-renowned team of pediatric doctors. None of those doctors spoke the Hmong language. From this initial collision – different languages, different religions, different ways of viewing the world – sprang a dendritic tree of problems that resulted in a medical and emotional catastrophe for Lia, her family, and her doctors.

When Lia first came to the hospital, the language barrier – an inability to take a patient history – caused a misdiagnosis. The next time she arrived, however, she was actively seizing. Thus, her doctors were able to determine her malady and come up with a game plan on how to treat it. For a variety of reasons (both spiritual and practical), the Lees did not follow the treatment plan, and Lia didn't receive the specific care her doctors ordered. Eventually, one of her doctors filed a petition with the court to have Lia removed from the home and placed into a foster home. This allowed for a rough sort of compromise to be reached. Lia’s treatment plan was simplified and made more palatable to the Lee’s wishes. On the other hand, the Lees promised to follow the new plan as prescribed. For a time, Lia seemed to thrive.

This détente looked good on the surface, but masked an unfixable wound to the relationship between the Lees and their daughter’s doctors. By the time the final seizure came for Lia Lee, her family actively distrusted the people working at the Merced Community Medical Center.

Fadiman intercuts her narrative of Lia Lee’s care with sections on the history of the Hmong in general and the journey of the Lees in particular. The Hmong people are an ethnic group who once lived in southern China. The Chinese pushed many of the Hmong from their borders, and they ended up living in Burma, Vietnam, Thailand, and Laos. During the Vietnam War, the CIA secretly recruited the Hmong to fight against Communism. When America pulled out of Vietnam, a Communist government in Laos persecuted the Hmong, and many fled the country in fear of their lives. The Lees left northwest Laos, spent time in a Thai refugee camp, and eventually ended up in California, where Lia was born.

Fadiman explores the complicated system of rituals and beliefs that govern traditional Hmong life. The Lees, like many Hmong, are animists, with a belief in a world inhabited by spirits. This faith dictated how the Lees understood Lia’s illness and how they wanted it treated. Ultimately, it led to problems.

I read The Spirit Catches You and You Fall Down for as part of my book club, the Eastern Nebraska Men’s Biblio & Social Club (formerly known as the Husband's Book Club, after we realized our wives were having all the fun. We later changed the name, because sometimes we just end up drinking). It came as a surprise pick from one of our quieter members, but proved to be one of our best choices. There are a lot of things to discuss. A veritable cornucopia of debate, dissention, and gentlemanly disagreement: Vietnam, CIA, Laos, and the debt owed the Hmong; refugee crises and how they are handled; the assimilation of refugees and immigrants; and even end of life decisions.

We met to discuss this book at a local brew pub where we could drink IPAs and eat pretzels with cheese. Most of us got pretty drunk. Usually, six drunks sitting around a table can solve most of the world’s problems. In this case, though, we mostly ended up in total divergence. I think that’s a testament to Fadiman’s willingness to take on every third rail in modern American life: religion, race, and the limits of government intervention.

(An aside: One of Fadiman’s chapters, called “The Life or the Soul,” posits the question of whether it is more important to save someone’s life – in which medical decisions trump all – or their soul – in which a person wouldn’t receive certain treatments that contradicted their deeply held beliefs. I’m not sure if it was the high alcohol content by volume in the beer, but the club somewhat surprisingly split 3-3 on the issue. Having known these guys for years, I was under the impression – wrong, as it turns out – that they were all secular humanists).

Judging from other reviews I’ve read, this is a book that angered people. Much of the vitriol is aimed at the Hmong who are accused, among other things, of being welfare mooches (this book was published right before Clinton signed the Personal Responsibility and Work Opportunity Act, gutting welfare); of ingratitude for the millions of dollars of free medical care they received; of parental negligence; and for their refusal to assimilate into American society. If you read this book and only feel anger…Well, I’d never tell someone they’re reading a book wrong, but in this case, you’re clearly reading this book wrong. These are difficult, fraught topics that Fadiman handles with grace. There are no heroes and villains. There are only individuals doing the best they can with what they have, based on who they are. It should also be noted that Fadiman is a beautiful writer, and in terms of sheer journalistic enterprise, I’ve rarely stumbled across a better example of diligent, on-the-ground research.

Fadiman isn’t out to piss people off. She does not structure her book to lay blame at anyone’s feet. Nevertheless, the central conflict of her story pits the Lees versus her doctors. Who was responsible for Lia’s fate? The parents who did not follow their doctors’ orders? Or the doctors, who never took the time to understand their patient, her family, and the context in which they lived their lives?

On this question, Fadiman is admittedly biased. It is a gentle bias. She faults the doctors for a lack of cultural curiosity, yet admits that – in order to gain the Lees’ trust – she spent hundreds and hundreds of hours with them, speaking to them through a handpicked interpreter. The time she spent allowed her to see the Lees as fully formed people, not the seemingly-ignorant, oft-mute “other” that presented at the hospital. She recognizes that it’s hardly reasonable for any doctor to spend hundreds of hours with a single patient just to understand how they view the world.

There are moments where, though, when I think that Fadiman is rather a bit too hard on some of her non-Hmong interview subjects. She gets intensely irritated with a waitress who says the Hmong are bad drivers. (I don’t know why this angered her. It’s perfectly rational to think that the Hmong, unable to understand American traffic signs, might be terrible behind the wheel. My dad and I once drove from Paris to Normandy. Neither of us speak French. We were honked at the entire time. Literally. The entire time. Don’t know why. To this day we don’t know why). Her sympathies lie with the Lees, and perhaps rightly so; yet she isn’t quite willing to extend the same empathy or generosity of viewpoint to others she comes across. I wonder if she’d have the same tolerance for a white anti-vaxxer who doesn’t have their kid inoculated for a deadly disease, or a Jehovah’s Witness who refuses consent for a child’s blood transfusion.

I like to think of myself as generally broadminded, with a liberal and accepting heart. Like Jesus, with more wine. As a parent, though, I found myself periodically raging against the Lees. This is your kid! Give her the correct prescriptions! Just do it!

At the same time, I recognize the need for doctors to better remember their patients are people. I’ve dealt with a chronic medical condition for the last couple years that has sent me on a semi-desperate search for a specialist who would listen to me. I’m a college-educated white male with health insurance who often wore a business suit to my appointments since I came straight from work. If I couldn’t get a doctor to give me five minutes of uninterrupted time, I can only imagine the experience of an indigent, non-English speaking patient who walks into the hospital with a life experience 180-degrees different from his or her physician.

One of the book’s final chapters, “The Eight Questions,” provides a nice roadmap for doctors. The titular questions, devised by a Harvard Medical School professor, are a deceptively simple, brilliant way of allowing the doctor and patient to share roughly-equal footing in the patient’s treatment. It shouldn’t be a binary question of the life or the soul, with the doctor standing in for God.

When I love a book, I talk to people about it. In doing so, I found that it’s on a lot of different curriculums. One of my friends read it for an undergrad ethics course. Another of my buddies, we’ll call him Dr. B, had it assigned while he was in medical school.

ME: Did you read it? It’s really good.
DR. B: No.
ME: Why not?
DR. B: Because I was studying medicine.

His answer is what I expected, and why I hope this book continues to get read.

(Final aside: The Spirit Catches You and You Fall Down was researched in the 1980s and published in the 10990s, meaning that the Hmong experience in America has changed, often drastically. I recommend getting the Fifteenth Anniversary Edition with a new Afterword by Fadiman. The Afterword provides a nice little update, as well as the cathartic tying of some loose ends).

[Nataliya]

This book for me was truly emotionally exhausting. A story of a real tragedy - the collision between two conflicting systems, a spectacular culture clash, with a little girl caught in the middle while everyone genuinely wanted to do what was best for her, with these efforts clashing and hurting everyone involved.

And everyone - everyone - involved just wanted what was best for little Lia.

Unfortunately, nobody seemed to agree what that actually was.

“Lia’s case had confirmed the Hmong community’s worst prejudices about the medical profession and the medical community’s worst prejudices about the Hmong.”

Written after years of painstaking research and detailed interviews by Anne Fadiman, this book focuses on little Lia Lee herself - a baby, then a toddler, then a child suffering from a very severe form of epilepsy and ultimately entering a vegetative stare after prolonged status epilepticus and sepsis leading to organ failure following several years of progressively worsening condition; her doctors - so many of them - working hard to do whatever they could to help her based on their knowledge of Western medicine; her parents who also did everything they could to help their daughter based on their knowledge of Hmong customs; and painful, tragic, often unnecessary and heartbreaking misunderstandings and tensions that came from the pull and push between everyone involved; and an attempt at portraying the Hmong culture to the readers mostly unfamiliar with it.

“It was as if, by a process of reverse alchemy, each party in this doomed relationship had managed to convert the other’s gold into dross.”

Fadiman does her best to remain impartial, to give everyone involved their chance to speak out, to give cultural context to her best ability. Does she quite succeed at that is for the reader to decide, but I think her heart lies with Lia’s family, although she does acknowledge how easy it is, while feeling such pain for the family and the entire community, start dismissing the medical viewpoint — and reminds us of that, so that we do not comfortably settle with supporting one side over the other — because even in a book built on stark contrasts of two very different cultures everything is much greyer than one would want:

“Once, several years ago, when I romanticized the Hmong more (though admired them less) than I do now, I had a conversation with a Minnesota epidemiologist at a health care conference. Knowing she had worked with the Hmong, I started to lament the insensitivity of Western medicine. The epidemiologist looked at me sharply. “Western medicine saves lives,” she said. Oh. Right. I had to keep reminding myself of that. It was all that cold, linear, Cartesian, non-Hmong-like thinking which saved my father from colon cancer, saved my husband and me from infertility, and, if she had swallowed her anticonvulsants from the start, might have saved Lia from brain damage.”

I find it very hard to talk about this as a book given that this is a story of recent real lives of real people, people who agreed to talk to Fadiman, people who are all united by doing whatever they thought would be best for Lia. There was no malice, no neglect, nothing wrong — and yet, when put together, it all became a part of a tragedy fueled by cross-cultural misunderstanding.

You know what rendered me speechless? When I entered “Lia Lee” into Google to see what ultimately happened to her (she died in 2012, at age 30), Google sidebar stated this: “Lia Lee. Fictional character.” And this was so staggeringly heartbreaking — this algorithm reduction of a real little girl from a real family, treated by real doctors to a book character.

It was emotionally very hard to read, and took me a long time — to recover, to regroup, to stop trying to assign blame in that very human defensive response — because this is indeed a situation where nobody and everybody is to blame.

Nobody was right. Nobody was wrong. And Lia was caught in the middle.

And so no rating — because I don’t think I can possibly assign “stars” to something that felt like a gut punch to the soul.

It’s a good book. Just don’t expect to have a good time when you read it.

——————
Recommended by: Left Coast Justin

[Lisa Vegan · Rating 5 out of 5]

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 is definitely that of an American (well, a subculture anyway, as there are obviously many cultures within America!) and I am fairly wedded to it, but I really appreciated this look into a culture so different from my own.

Anne Fadiman does a remarkable job of communicating both sides of this story; it’s probably one of the best examples of cross-cultural understanding that I’ve ever read. It’s ostensibly about a young Hmong girl with epilepsy and her family’s conflict with the American medical establishment, and there is much about them here.

But it’s also a wonderful history book. There’s much background about the Hmong people going back centuries and recent history also. It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland.

I learned so much about the Hmong people; I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context. And, as I was reading, I was really struck by how cultural differences (and the cultural differences between the Hmong and American cultures is about as far apart as it gets) can completely hinder communication if they’re not acknowledged and attempts are made to bridge the gap. This is a great book to read if you want to try to understand any people who are different from you in any way.

Beautifully written and an enjoyable read.

[Jenna ❤ ❀ ❤ · Rating 5 out of 5]

"If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”

I often say that one of the things I most love about Goodreads is that I "discover" through friends' reviews books that I might otherwise have gone my entire life not knowing about. 

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

My GR friend Elizabeth wrote a beautifully compelling review and I knew I had to read this book.
Wow.

Wow. Wow. Wow. 

I can't begin to say how much I loved this book.

It is the story of Lia Lee, a young Hmong girl whose family had immigrated to the United States after the Vietnam War. Young Lia was severely epileptic and caught between two vastly different cultures. 

Because her parents had different ideas of illness' cause than Western doctors, they also saw healing in a different light. They believed Western doctors were overmedicating and harming Lia; the exasperated doctors thought the Lees were irresponsible when they didn't give Lia all of her medication or on the strict schedule they prescribed. 

This story is tragic and I went into it fully thinking I would be on the side of the doctors. I am scientifically-minded and perhaps a bit ethnocentric when it comes to certain areas like medicine and science. 

However, author Anne Fadiman presents both sides in a compassionate light and it's impossible to not see some things the way the Hmong do and to admit that Western medicine, for all the lives it saves, is not 100% perfect.

Young Lia was caught between two cultures and her health suffered for it. On one hand, as the author points out, Lia probably would not have survived infancy if not for Western medicine. And yet, it very well might have been that same medicine that was responsible for leaving her brain dead at the age of four. 

I love how the author tells the story of Lia and also that of her family and that of her ethnic group, the Hmong. 

The Hmong are a clan without a country, most recently living in China and then Laos. They have historically refused to acclimate to the dominant culture, preserving their traditions and remaining fiercely independent.

After the Vietnam War, in which the US used Hmong men and youth (children as young as 10 years of age were given weapons) to fight the communists, the Hmong had no choice but to try to escape to Thailand. 

Many eventually immigrated to America, a country whose culture is vastly at odds with theirs.

In the past, I have always felt it the duty of an immigrant to try to assimilate as much as possible into the dominant culture. Reading this book, that idea was challenged.

On one hand, I still think it is a good thing, especially for the children and grandchildren of those who immigrate. On the other.... well, I'm just not so sure anymore.

I read this book and began seeing things through the eyes of the Hmong people, and of other refugees. I don't know where I stand now on the concept of assimilation. It's definitely not a black and white area but rather a large grey one. 

No, people cannot move to another country and expect to not follow certain rules, but should we really force them into "becoming American", especially when we continue viewing immigrants as "other" unless they are Caucasian? 

I don't have the answers but I think it is cruel to expect a person to leave behind all of their cultural beliefs and traditions. I just don't know how much and how far this should go but it's not for me to say.

What the Hmong historically suffered is devastating to read about. What many went through when they came to America is also devastating. The prejudice and ethnocentrism they endured is shameful. 

I cannot begin to imagine what it is like to be forced to leave your homeland, not knowing if you will ever be able to return. To leave behind friends, family, all of your belongings. And then to go to a country whose language you do not know but are expected to immediately learn, and to be seen as a burden, at best, to your neighbors who resent the monetary assistance you receive. To be seen as an evil, ignorant savage by others, whose culture should be wiped out.

The terror and confusion the Lees felt as they tried to make sense of what Lia's doctors wanted to do was palpable. Ms. Fadiman writes with so much compassion and insight for all involved. The doctors, the nurses, CPS workers, the Lees. 

The only thing I disliked about this book is that there is a lot of animal sacrifice. I struggled with that as an animal lover who hasn't eaten meat for more than half my life (yes, we can survive just fine without it).

However.....

It infuriated me how the Lees were seen as ignorant and evil because they killed animals in hopes of appeasing the spirits who they thought had taken Lia's soul. 

As the author points out, these animals at least had had a good life before being killed, unlike those in Western factory farms which suffer horrifically their entire lives. And the Hmong eat just about every part of the animal, not throwing out much of it as Westerners do. 

The Hmong only eat meat about once a month, when an animal is sacrificed. That's a far cry from the typical American who eats it every day and sometimes at every meal.

It is hypocritical of Westerners to vilify the Hmong and other cultures for eating dogs when they eat pigs, which are even more intelligent than dogs.  A visiting nurse in the book angered me by telling the Lees they should raise rabbits to eat instead of buying rats at the pet store. She insisted rats are dirty and shouldn't be eaten. Well, contrary to Western "wisdom" rats are extremely clean animals and these ones, coming from the pet store, they were not carrying disease. 

Why is it evil to kill and eat one type of animal and not another? The only difference is what one grows up with as 'normal'. It drives me crazy when I hear Westerners ranting about how horrible Chinese people are for eating dogs and cats, while they're shoveling down a burger, some bacon, or a piece of veal.  

Shut up and go home with your hypocritical and ethnocentric ideas.

OK, let me step off of my soapbox......

This book is so brilliantly written, even though it is tragic. The author's respect and admiration for both sides is apparent and she writes with utmost compassion. It is impossible to read this and "pick a side". 

Highly recommend. This isn't a book I'll be forgetting any time soon.

To read Elizabeth's brilliant -and more informative- review of this book, click here

Thanks, Elizabeth!

[Inder · Rating 4 out of 5]

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 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 parents. At the same time, given their history, you can fully appreciate her parents' dislike of hospital procedures and distrust of distant, superior American doctors. There are no heroes or villains here. The book is perfectly balanced. When Lia ends up brain dead, your heart just hurts for everyone involved.

There are a couple of reasons I finally settled on four stars: (1) While the historical background provided in the book is excellent, it drags the story down. I felt it could have been better incorporated into an otherwise almost flawless narrative. (2) I found myself questioning the basic premise of the book. I'm not sure that cultural misunderstandings caused Lia's eventual "death" (brain-death, that is). Lia's epilepsy, by all accounts, was unusally severe and unresponsive to medication. So I was never convinced that a white, middle-class American girl would have survived with her mind in tact, either. This is not to dismiss the very real cultural struggle that this book describes, but some of the author's statements about how cultural misunderstandings "killed" Lia seemed a bit speculative to me.

But overall, this is an absolutely beautiful, touching book, and should be required reading for everyone in California (and everyone else, too).

[Paul Bryant · Rating 4 out of 5]

I guess this all starts with President Eisenhower, who was big on the Domino Theory so he got the CIA to figure out some people who lived near China who might want to fight the communists on behalf of the USA. Because of course the USA could not be seen to be fighting directly, that would be a violation of something or another. One of these groups was the Hmong people in central Laos. I had never heard of them either.

It wasn’t that these Hmong hated the communists, but they got the idea that the communists were going to stop them farming in their own Hmong way. So they became CIA patsies, or brave American allies, according to your perspective. Then in 1975 the Hmong found themselves on the wrong side of the argument when the communists took over Laos, and they began to get the hell out of Dodge, to coin a phrase.

Long story short, a lot of them congregated in Merced, in California. No, I never heard of Merced before, either, and for sure the Mercedians never heard of the Hmong before 1978, but then they did.

Now these were not people emigrating to America with the desire to become Americans and wave the flag and sing the Star Spangled Banner and eat burgers. They wanted to remain as Hmong as they could. So most of them declined to learn any English. Not surprisingly they were mostly on welfare. They became known as the “least successful refugees”.

It was shocking to look at the bar graphs comparing the Hmong with the Vietnamese, the Cambodians and the Lao…and see how the Hmong stacked up: most depressed. Most psychosocially dysfunctional. Most likely to be in need of mental health treatment. Least educated. Least literate. Smallest percentage in labor force.

Also not surprisingly, there was an impenetrable gulf of misunderstanding between the Californians and the Hmong. As an example, a health worker visited a Hmong family to check on their daughter – this family is who the book is about. Health worker says to the interpreter “It is good if mama can take her pulse every day.” Interpreter says “She says they don’t know how to tell the pulse.” Health worker says “Well, you just put your finger here, and take your watch, and count for a minute.” Anne Fadiman comments :

Foua (the mother) didn’t own a watch, nor did she know what a minute was.

Here’s a more upsetting example :

A Hmong child in San Diego was born with a harelip. Her doctors asked the parents’ permission to repair it surgically. They cited the ese of the operation, the social ostracism to which the child would otherwise be condemned. Instead, the parents fled the hospital with their baby. Several years earlier, while the family was escaping from Laos to Thailand, the father had killed a bird with a stone, but he had not done so cleanly, and the bird had suffered. The spirit of that bird caused the harelip. To refuse to accept the punishment would be a grave insult.

DON’T TOUCH A NEWBORN MOUSE

Some more Hmong beliefs about illness :

Falling ill can be caused by various things, like eating the wrong food, or failing to ejaculate completely during sexual intercourse, or neglecting to make the correct offerings to ancestors or touching a newborn mouse or urinating on a rock that looks like a tiger. But a whole lot of illness is caused by dabs. A dab is an evil spirit which can suck your blood and do all sorts of stuff. So your illness might be caused by bumping into a dab who lives in a tree or a stream, or if you catch sight of a dwarf female dab eating earthworms or just because a dab likes the look of your soul and lures it away from you. That will make you real ill.

Hmong healthcare centered around sacrificing a pig or in more serious cases a cow in the family home. A shaman would be there to conduct the right ceremony. Then some herbal remedies, and everything would be ticketyboo.

The American medical profession was not especially interested in all of this and Anne Fadiman is not saying they should have been, either, but there was such a brutal lack of comprehension on either side that when this family’s youngest daughter was born with severe epilepsy, a trail of disaster started that led to this girl ending up with what the doctors called hypoxic ischemic encephalopathy (static), yes, what you might call a persistent vegetative condition. Alive, but dead.
Lia, this girl, was in and out of hospitals more times than you could count, and sometimes in intensive care, and still it all went wrong. A doctor casually calculated the total cost to the state of Lia’s care:

$250,000

WELL, WHAT IS THE TRUTH?

Well-meaning health worker :

I’m not very interested in what is generally called the truth. In my opinion, consensual reality is better than the facts.

Anne Fadiman never says that this whole elaborate spirit world belief system is nonsense. Never. But to a Western reader that kind of hovers in the air throughout the whole book. She does say that it would be impossible for Western medical practitioners to think that “our view of reality is only a view, not reality itself”. Because empirical Cartesian science-based clinically-trialled peer-reviewed Western medicine IS thought to be true, not just one of several possible truths.

The Hmong were an isolated ethnic group, they didn’t intermarry with the Lao, and you can imagine their beliefs have been consistently handed down for centuries. These days we are seeing alternate-reality belief systems sprouting all over the place on social media, so that there is now as much of a gulf between a Stop the Steal conspiracy theorist Trumpster and a normal person as there was between the Hmong and their Californian doctors.

This is a plainly written always fascinating assumption-challenging great read. It spent 6 and a half years on my shelf before I read it.

Very recommended.

[Jenny (Reading Envy) · Rating 5 out of 5]

What an incredible read! A clash of Western medicine with Hmong culture, exasperated by a lack of translators, cultural understanding, and education on both sides. Anne Fadiman shows how the situation involving one very sick child went wrong and makes suggestions as to more effective ways to communicate and provide care. I really enjoyed learning about the Hmong family in particular, and their own methods of parenting and treating the sick. The author suggests that millenia of Hmong people refusing to be assimilated effects the challenges facing Hmong refugees in their new environments, so she covers quite a bit of Hmong history, particularly in Laos, and how that intersects with American history thanks to "The Secret War." This is going to be a great book club discussion!

The edition I read had a new afterword by the author providing some updates and discussion of the impact of the book. She also talks about how it would have been impossible to write now, at least not in the same way.

[Teresa · Rating 4 out of 5]

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, it also explains the background of the Hmong (historically, a migrating people without a country) and their CIA-recruited role in the American War in landlocked Laos, a place they didn't want to leave but were forced out of, and how so many of them ended up in Merced, CA.

There's a lot to learn here, but the most important thing for me was the, perhaps needless, conflict and heartbreak that can result when bureaucracies try to fit everyone into their one-does-not-fit-all pigeonholes.

[Diane · Rating 4 out of 5]

This is an impressive work! "The Spirit Catches You and You Fall Down" is a nonfiction book I've been meaning to read for years, and I'm glad I finally made time for it. Anne Fadiman writes about the clash of two cultures: Hmong and Western medicine. By following one Hmong family in California as they struggle to care for their epileptic daughter, we see how difficult it can be to assimilate, especially when there are strong differences in the culture of healing. Fascinating and engaging, I highly recommend this book.

[Eric · Rating 5 out of 5]

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 conduct your life once you realize that you really have no idea what underpins most other people's framework of reality and have no claims on the truth. It makes you want to beat a hasty retreat from judgment and be a better person. It makes you want to listen more, forgive more, learn more about people, and allow for more realities. It's an important certainty-challenger. Highly recommended.

[Roy Lotz · Rating 4 out of 5]

I opened this book expecting to learn about a specific people (the Hmong), in a specific time and place (contemporary America). But Anne Fadiman has achieved the success of a great novelist: illuminating the general with the particular. The story of Lia Lee, an epileptic daughter of Hmong refugees, turns out to have wide and deep implications.

The most obvious question asked by this book is: how should Western medicine deal with members of radically different cultures? This is a practical as much as it is a moral question. As Fadiman makes painfully clear, cultural misunderstanding was the primary culprit in Lia’s medical tragedy. The doctors did not understand that the Lee family believed, valued, or thought; and the Lee parents generally had a very different interpretation of the doctors’ actions and Lia’s illness. This caused a tremendous degree of miscommunication that could potentially have been avoided if the medical personnel had had better procedures for bridging cultural gaps.

This story also sheds an odd light on the current conflict between public health officials and anti-vaxxers. A major tension was the parents’ resistance to administering anti-seizure medication. (They did not trust that it would work, and also probably had a hard time following the regime due to their illiteracy.) At one point, the doctors even called child protective services to place Lia in foster care, because of the parents’ non-compliance with the doctors’ orders. As Fadiman makes clear, both doctors and parents were doing what they believed to be the right thing, according to their knowledge and beliefs. Doubtless the same dynamic is playing out in the current pandemic with regards to the vaccine.

The question is: How should respect for individual autonomy, empathy for differing beliefs, and a need to protect health be balanced when these values conflict? There is a very good argument to be made that health trumps every other value—since you can have neither beliefs nor autonomy without life. However, as Lia’s story demonstrates (and I am trying not to spoil too much), applying too much force can undermine the very thing we are trying to protect. In other words, health is promoted by autonomy and empathy, too—sometimes at much as it is promoted by medicine. I doubt very much that this conundrum has any generic answer.

The story of the Hmong also sheds an illuminating light on the recent Afghanistan withdrawal. This particular passage is quite eerie to read now:

Several times the planes were so overloaded they could not take off, and dozens of people standing near the door had to be pushed out onto the airstrip. … After the last American transport plane disappeared, more than 10,000 Hmong were left on the airfield, fully expecting more aircraft to return. When it became apparent that there would be no more planes, a collective wail rose from the crowd and echoed against the mountains.

For those who do not know, the Hmong were (illegally) recruited by the CIA to fight a secret (and illegal) war in Laos. After it had bombed half the country into oblivion, the U.S. finally turned tail and pulled out, leaving thousands of people who had fought for us in hostile territory, forcing them to flee for their lives. Many (like the Lees) made it to Thailand, and eventually to the United States as refugees. Ironically, but unsurprisingly, these refugees (many of whom were veterans) faced racism and discrimination in their new home—a backlash that eventually made it more difficult for refugees to enter. Does any of this sound familiar?

To keep this review short, the story of Lia Lee, while treading lightly, leaves enormous footprints in the reader’s mind. Anytime we are faced with a radically different worldview (such as the Hmong’s), we are faced with the disturbing question: How far can our own culture—or own version of reality—be trusted? But this book goes beyond that unanswerable question to examine many that can be answered: How should we treat refugees? How can we bridge cultural divides? How can we make medicine more humane? It is an enlightening read.

[Left Coast Justin · Rating 5 out of 5]

Rarely do I read anything that appeals to the heart and the brain in equal measure, rarer still one that both appeals and challenges. It is hard to believe that one book managed to teach me more than any other and made me feel more as well. The words tour de force were invented for works like this.

This book succeeds on so many levels...As a primer on organizing huge amounts of information into a highly readable format, for one thing. Equally as an introduction to Hmong culture, and no less U.S. medical culture. Throw in perfect illustrations of the joys and agonies of parenting, numerous examples of fine expositional writing, a compelling family saga, and what am I forgetting?

Doctor: "How long have you been having these headaches?"
Hmong patient, calmly: "Since I got shot in the head."

I'm forgetting something, surely. Perhaps the image of Hmong immigrants "hunting pigeons with crossbows in the streets of Philadelphia," or maybe the final chapter, which provoked the strongest emotional reaction to a book I've ever had, or maybe even a social workers' assessment of the main family's parenting style: "high in delight". Then there's the horrific essays the younger Hmong kids innocently turn in to their shellshocked Californian teachers, and I could go on and on.

This is the best book I've ever read. Out of hundreds. And with all the books I love, none of them come close to this one.

[Mmars · Rating 5 out of 5]

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 misunderstood in America at this time while Mia and her family knew only their own culture and language. What ensues is a series of missteps, mistakes, and, again misunderstandings.

This is an eye-opening account of multiculturalism, social services, and the medical community. There were and are no easy answers, but there always are lessons to be learned, and a lot can be learned from this book.

I found it a fascinating read, clearly written. It is heartening to learn that this book is being used in educational settings. A must read for anyone who works in a field involving interaction with peoples of various cultures as well as lay readers.

[Rosie Nguyễn · Rating 5 out of 5]

This is one of the best books I've ever read. It's so good it makes me speechless. I can only say, I wish I could write a book like that one day.

[Beverly · Rating 4 out of 5]

In Hmong culture they revere their children so much, it is wonderful. This little girl was her parent's favorite and they believed her epilepsy was a special gift that made her more in tune with the spirit world. Many of the spirit healers in Hmong society have epilepsy.
More largely, this is the story of a clash between western and eastern cultures, a communication lapse that ultimately ended up hurting the parents of this little girl very profoundly.

[Heather · Rating 4 out of 5]

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.

[Hamad · Rating 3 out of 5]

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?

[Elizabeth · Rating 5 out of 5]

Published in 1997, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures is a remarkable masterpiece that feels just as significant today, more than 20 years after being published, for its commentary on cultural differences, social construction of illness, and most important of all, empathy.

Lia Lee was born in California's Merced Community Medical Center, or MCMC, in July of 1982 to mother Foua and father Nao Kao. At 3 months old, Lia experienced her first seizure, the resulting symptoms recognized as quag dab peg, translating literally to "the spirit catches you and you fall down." In the culture of Western medicine, this is epilepsy. For the Hmong people, treatment of quag dab peg would involve shamanism and animal sacrifices to bring back a lost soul. For American doctors, treatment of epilepsy would involve a cocktail of anticonvulsant medications, antibiotics, and sedatives. Who was right?

Following septicemia and a grand mal seizure, Lia entered a vegetative state at the age of 4. Foua and Nao Kao were repeatedly noncompliant about medication, and Lia was suffering as a result! What if they had properly given her medication from the outset of her very first seizures? But what if the doctors hadn't prescribed a medication that would compromise Lia's immune system? Perhaps she would never have gotten septicemia, causing her to go into shock and then seizure. Doctors assumed her death was imminent, but Lia in fact lived to be 30 years old, outlived by Fuoa and her siblings. To the very end, she was treated with unwavering love and care by her family. Again, who was right?

In one of the most open-minded works of nonfiction I have ever read, Anne Fadiman analyzes both perspectives—Lia's family and the community of Hmongs on one side and the Merced doctors and nurses on the other. The cultural barriers felt insurmountable and frustrating. It was disheartening to see so few individuals who were able to act as cultural brokers, either American or Hmong, but from every corner there were truly good-hearted people who did everything they could to save Lia, heroes in their own right. The what ifs are endless, but this book serves as a lesson: as much as cultural barriers may be a behemoth to overcome, they are never insurmountable.

This is a must-read, especially if you know little about the Hmong as I did. Through ignorance, people confused the Hmong living in American communities as being Vietnamese, even lumped falsely with the Vietcong. In reality, an army of Hmong guerrilla fighters were recruited, trained, and armed by the CIA in the 1960s to fight against communist forces in Laos. Fadiman delves deep into the history of the Hmong people, though by no means comprehensively. The Hmong are so much more than any myopic or racist assumptions—they are rich in folklore, tradition, stories, and identity.

Though this book is nonfiction, every page is steeped in emotions both harrowing and uplifting. Though you want to put blame somewhere, on someone, for the tragedy of errors that transpired, there is ultimately no villain. It is difficult to acknowledge that no one was right but so easy to fall into a trap of uneasiness and ignorance in the face of the Other, writing such people off as enemies. There were no easy questions or answers in this book but an overabundance of strength, love, anger, frustration, and empathy. The Spirit Catches You and You Fall Down is emotional, challenging, complex, and informative. To me, those make for the most important and powerful books. I won't ever forget Lia's story, and I hope everyone in their own time will discover it too.

[Sleepless Dreamer · Rating 5 out of 5]

I've never quite read a book like this.

Essentially, The Spirit Catches You and You Fall Down is about the medical struggles of a child with epilepsy. However, through this narrative, Anne Fadiman discusses cultural challenges in medicine (and in general), immigration, Hmong history and culture, and trust in an incredibly thorough and fascinating way.

I find that it's easy (for me, at least) to fall into two camps when talking about different cultures and medicine. Either I find myself thinking that medicine is relativist thing and so each culture has its own valid way of treating ailments cause heck, who knows how this world even works. Or I think that Western medicine is just simply better for everyone and people who believe that an animal sacrifice can heal a child shouldn't be given children.

Now, in this book, Fadiman tackles both of these mindsets and manages to find the middle ground. She doesn't veer into either side. There's something so fantastically moderate and intelligent about the way she discusses this topic.

Moreover, through this book, it's so easy to empathize with everyone. I was skeptical at first but around the middle of the book, I found myself thinking that the fears of Lea's parents are so understandable and that they were really doing what they felt was right. Their fears became so visual and vivid for me. Fadiman highlights how in so many ways, the medical failures were no one's fault and yet, they could have been avoided. Finding this form of balance is truly an impressive feat.

Reading this book felt like an applied form of 21 Lessons for the 21st Century. Harari discusses the four topics of immigration. One of them is precisely whether the state owes something to immigrants. It's clear that the Hmong people feel (and quite rightfully, I'd say) that the states owe them something for their help in the war and yet, looking at the way they were treated, it's clear that this mindset is not shared by the states.

In many ways, this is even more interesting because the Hmong would like not to be on welfare and the Americans would like them not to be on welfare but somehow, precisely because of the cultural differences, everyone ends up unhappy. It could have been a win-win situation but ended up being a lose-lose situation. This is different to what I usually think about when considering cultural differences (like, an Ultra-Orthodox Jew wants no cars on his street and a secular person wants to drive- it's a zero-sum game).

There's so much that this book has within it but ahh, I haven't finished my Econ homework so this might be a good place to stop. Although it was written in 1997, it remains remarkably relevant for so many contemporary issues. I feel convinced that several of the ideas here will stay with me for a while.

What I'm Taking With Me
- I would absolutely love to see would Fadiman research about every controversial topic ever.
- Am I still bitter about that one paragraph that compares the Hmong people to Jews and claims that they are more impressive because they're not bound to a religion together? Just a little bit.
- Cultural brokers are important! Combining medical treatments with religious ones, making sure everyone understands each other, taking the time to ask people how they perceive their illness!

[Jeanne · Rating 5 out of 5]

I especially appreciate books that help me see the world differently, whether they are mysteries, literary fiction, vampires, or nonfiction. When they are as thoughtful and engaging as this one, I have found a treasure.

Anne Fadiman's book, The Spirit Catches You and You Fall Down: A Hmong child, Her American Doctors, and the Collision of Two Cultures, does just that. She probably hears the Hmong family better than she hears Lia Lee's doctors, but Fadiman tries to understand both.

Lia Lee had a series of seizures starting from age three months, but perhaps due to a misdiagnosis, experienced a severe seizure that put her in a coma. While expected to die, she lived an additional 26 years, adored by her parents and family – and also by Fadiman. Lia's life, especially her early life, was characterized by significant strife between her parents and the medical system. Some of these challenges:

* Who should be grateful to whom? The Hmong, for the welfare they received in the US? Or the US, for whom the Hmong had fought long and hard, at cost of life and country?

* How do you judge the "success" of a refugee group? Their use of welfare or social indices like crime, child abuse, illegitimacy, and divorce, all of which were especially low for the Hmong?

* What is the cause of illness? Some biological force run amok, like Lia's physicians believed, or soul loss, as the Hmong believed?

* Surgeons believed that removing cancer kept a person alive, but the Hmong believed this would be at risk of his soul, at risk of his physical integrity in the next life. What Hmong would risk that?

* US doctors believed they were helping Lia, while the Lees thought their treatments were killing her.

* Like her doctors, Lia's parents wanted her healthy, but "we are not sure we want her to stop shaking forever because it makes her noble in our culture, and when she grows up she might become a shaman" (pp. 260-261).

How should we handle these differences? When we perceive difference as threatening– including threatening our cosmology of the world – we tend to reject it and see the other person or culture as wrong or inferior. If we do, how can we work effectively with someone different from ourselves? She argues:

“As powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” (p. 261)

Ah! If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture? Good question.

Fadiman argues that we should take a step back, acknowledge other perspectives, and listen. This attitude of cultural humility can be difficult to adopt, especially if you prefer thinking in terms of right and wrong, but it can be useful.

And might have saved Lia Lee.

[Chelsea · Rating 5 out of 5]

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 there isn't anyone person or group who can be blamed for what happened to Lia. The point of the book is to take a look at the differences in cultures that exist in our country today, and maybe realize that there are better ways of dealing with the issues that arise.

The look at the Hmong culture and history the book provides is fascinating and enlightening. The different levels of engagement the Lee family had with various westerners was particularly telling, and explained a lot about the wildly varying opinions people had formed.

The story of Lia Lee is tragic, and the possibility that it could have turned out differently makes it especially so. It's been over ten years since the book came out, and I would love to have some kind of update as to how the Lee family is doing - especially how Lia is doing - and if there has been any real progress made in solving culture collisions in Mercer.

[Phyllis Runyan · Rating 4 out of 5]

The first, spontaneous reaction with regard to the stranger is to imagine him as inferior, as he is different from us.

Lia Lee's parents immigrated to this country in the early 1980s from Laos. They were of the Hmong culture, a people who inhabited mountaintops and all they wanted was to be left alone. During the war they sided with the Americans. Their men joined the military some even becoming pilots. When the war was lost, they had to leave their country or die. They were promised a place in the US and eventually thousands immigrated to the US and other countries.
The cultures were so extremely different as the title suggests, A Hmong child, Her American Doctors and a collision of cultures. And this is Lia's story about epilepsy and the wrong treatment.
The author did years of research both of the culture, the people and their history and the medical treatment. This should be a must read for all medical personnel.

[K · Rating 5 out of 5]

"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 her doctors, who were extremely frustrated at all the barriers in dealing with this family and felt understandably determined to treat Lia according to the best standards of medicine. Then you have the people in between -- the sympathetic and aggressively advocating social worker (resented by the doctors) who came from the American point of view but aligned with the family; Lia's temporary foster family who ended up forming an apparently close relationship with her birth family; and the author herself, who unpacked this story with all its layers and recognized the profound questions it elicited, such as:

What’s preferable from a doctor’s point of view – a lower standard of care with a higher probability of compliance from the family, or a higher standard of care with a lower probability of compliance from the family?

When a child is involved, who's the boss -- the doctor, or the parents?

Why are we Americans so intolerant of those who do not wish to assimilate into our culture? And do we owe them the same rights/privileges as those who adopt American culture?

How could the Lees be perceived so radically differently by the doctors and nurses who worked with them vs. the more sympathetic social worker and journalist?

If the doctor's goal is to save the body and the family's goal is to save the immortal soul, who should win that conflict?

This book was amazing, on so many levels.

The writing was excellent, and so was the organization. I find that non-fiction books often err on the side of being either informative but too dry, or engaging but also too sensationalist/one-sided. This book was neither. The story was gripping, and so was the background (and Fadiman did a great job of interspersing the two so as to build tension, and so that neither aspect of the book ever got boring). Fadiman has clearly done her research, and I felt like I learned a great deal from the book but never felt like I was reading a textbook.

Best of all, this is one of the rare books I've read that felt truly balanced and three-dimensional. Fadiman was sympathetic to the Hmong and their viewpoint without romaticizing or idealizing them. She described some unfair racist reactions to the Hmong, but she also acknowledged the valid resentment felt by people whose taxes were supporting their welfare-receiving huge families. Fadiman also portrayed the doctors as motivated overall by good intentions. She acknowledged factors such as cultural blindness and the arrogance of the profession, but did not imply that the doctors were coldhearted, insensitive automatons -- quite the contrary.

Highly recommended for anyone who wants an engaging and thought-provoking read.

[Tamara · Rating 4 out of 5]

I rarely read nonfiction, but I found The Spirit Catches You and You Fall Down in a Little Free Library after a one-way run, and picked it up to read at a coffee shop with a post-run latte (pre-COVID-19, sigh). I started reading in line and only stopped since to squeeze in book club reads.

The Spirit Catches You and You Fall Down tells the tragic story of Lia Lee, a young Hmong child living in Merced, California. Her family came to the U.S. as refugees after escaping Laos via Thailand. As a child, Lia develops epilepsy, which her parents see as an auspicious sign suggesting Lia may have the coveted ability to commune with spirits. They take Lia for treatment, as needed, at the hospital and clinic in Merced, where they are distrustful of the doctors' aggressive, Western approach to treating Lia. The doctors, in turn, can't understand why Lia's parents do not administer her prescribed medications or take the steps they view as necessary to treat Lia's condition. Lia's parents, on their part, enlist shamans to help bring back Lia's soul and treat her with herbal remedies and poultices in the hospital and at home. The true tragedy of the book is the the utter failure for both sides to understand one another and address Lia's medical needs before they are beyond control.

The book jumps back and forth between Lia's story and the broader story of Hmong people, especially Hmong refugees in the United States, and the growing interest in cross-cultural medical care. The book was published in the late 1990s and was a major success, as both a sales juggernaut and in changing minds. It's now taught at medical schools around the country and it sounds like the stubborn approach of both Lia's doctors and her parents have been alleviated by greater understanding in the medical community about brokering cultural understanding between physicians and patients.

I was especially interested in this book because I traveled to Laos a couple of years ago, and had the opportunity to visit a Hmong village in the mountains above Luang Prabang. I learned a bit about their culture, which is so very different than my own. I really enjoyed learning more about Hmong people through this book, and if I go to Laos again in the future I will bring a greater understanding of Hmong people and the political backstory that led to such divide in Laos that endures today.

[Robbin · Rating 5 out of 5]

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.

[Emma Deplores Goodreads Censorship · Rating 5 out of 5]

This is a fantastic work of journalistic nonfiction. It begins with a toddler, Lia Lee, living in California in the 1980s. The daughter of Hmong refugees, Lia begins suffering epileptic seizures as an infant, but her treatment goes wrong as her parents and the American doctors are unable to understand and respect one another. The book expands outward from there, exploring the history and culture of the Hmong, their enlistment in the U.S.’s secret war in Laos, and their subsequent refugee experiences. And then too it is about medicine, the goals of American medicine and what it means for health care providers to be culturally competent.

Fadiman packs so much into just 300 pages (and that’s counting the 2012 afterword, which you should definitely read). And it’s so brilliantly done. She conveys tons of information, but in such an accessible and compelling way that the book is a page-turner; I sped through it in just a few days. She’s a fantastic storyteller, keeping the reader always wanting more, and at the same time, shows humility and a willingness to engage with difficult issues. She presents arguments from many different viewpoints, and all of them sympathetically; she isn't afraid of facts that run counter to her arguments, nor does she dismiss opposing opinions out of hand. After wrestling herself with a collision of two cultures, she comes out of it able to portray both worldviews, seeing the merits in everyone's arguments, and looking for better systems to solve problems rather than casting blame on individuals.

Overall, an incredibly thorough, thoughtful, and engaging work that I would absolutely recommend, regardless of whether you’re in the medical field (I am not). Happily, one can now also read memoirs by Hmong authors, such as The Latehomecomer, which tracks the experiences recorded in this book closely but from a first-person perspective.

[Samantha Newman · Rating 4 out of 5]

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 not stupidity, it's not lack of common sense, whatever. It's the fact that there are so many different cultures in this world, and growing up in any one of them makes just about everything about you so totally different from those in other societies. And is there any way to bridge those gaps completely? I don't think so. There's probably a way to improve cross-cultural relations though. Especially in a place like the US. This book brings up those questions and doesn't pose solutions but does give ideas at least to open up your mind and eyes to it all. And it gives facts about how things have been (poorly) dealt with, and the problems that causes. The case study Fadiman explores is a perfect example that you can kind of project onto other situations.

And the story itself is really interesting. Fadiman tells the story rather skillfully - (but?) you can tell she is a journalist, for better or worse, here.

This book was really enjoyable. It impressed me and taught me a lot and made me think about the issues it brought up - namely cultural issues - a lot. I'm glad I read it and I hope I keep it in mind when I encounter those from other cultures and have difficulties with how I may feel about them. Because I can pretend I'm not "culturalist" and I'm all open and accepting but when it comes down to it, I'm not.

[Merritt · Rating 3 out of 5]

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 of some hidden prejudices in myself: faith healing vs. medicine and a family's right to choose between them for a minor child especially, and to a lesser degree, a prejudice towards immigrants that live off of our health care and tax dollars without contributing to the national coffers. I was particularly uncomfortable with that last one because I respect people's right to look for a better life but apparently I want them to do so legally and not take advantage of our hospitality for several years. It's not one of my favorite books but it's interesting.

[Katie · Rating 4 out of 5]

4.25-ish
LOVED

[Book Concierge · Rating 4 out of 5]

Subtitle: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

The 150,000 Hmong refugees who came to the United States in the late 1970s arrived in a country and culture that could not have been more foreign to them. The Lee family had escaped their native village in the hills of Laos and settled in Merced California. In July 1982 Foua Yang gave birth to her fourteenth child; Foua and her husband Nao Kao Lee would name the little girl Lia. She was a loved child, tenderly cared for and pampered as the “baby” of the family.

When she was about three months old, however, Lia had a seizure. Her parents believed this was caused when her older sister had slammed the front door of their apartment, drawing the attention of a spirit who had caught Lia’s soul. The Hmong call this condition quag dab peg and consider it something of an honor to have these spirits possessing the child; such a person might even grow up to become a shaman. Still, the frequency and severity of the seizures worried Foua and Nao Kao enough that they took Lia to the Merced County Medical Center Emergency Room. There the lack of a common language or trained interpreters, and the clash of cultures led to disastrous results.

This is a fascinating medical mystery, and a balanced exploration of two very different points of view. No one acted with malice, everyone wanted what was best for Lia, but there was no way for the two opposing sides – Lia’s parents and community vs the doctors and social workers – could come to agreement. And the person who suffered was Lia.

I thought the book could have used more editing. Perhaps Fadiman believed that the reader needed considerable repetition to get the message (and she may be right about that), but I really didn’t’ need to be told – again – that the Lees believed a spirit was the cause of Lia’s problems, or that they believe the medicine made her worse, or that the doctors thought the Lees were difficult or poor parents.

Still, I was really caught up in the story, and appreciated learning more about the Hmong culture. I’m looking forward to my F2F book club’s discussion on this book.