1. Introduction- introduce the book, summarize what it is about, and then give your opinion about it, which is your Main Point
The book, The Spirit Catches You and You Fall Down by Anne Fadiman, narrates the pathetic story of suffering and death of Lia. It is the story of Lia, the thirteenth child of a Hmong immigrant family which was rehabilitated in California. The book vividly presents the cultural gap between the American doctors and the Hmong family which has taken the life of an innocent girl Lia. The book highlights the serious communication barrier between the doctors and the Hmong patient and clearly exposes the need for cross cultural understanding and training for the medical professionals.
Lia’s parents Foua and Nao Kao bring their daughter to the county emergency hospital when she was three months old. A series of events leave the American doctors and the parents of Lia in a helpless position and their best intentions and sincere attempts to save the girl go in vain. The parents of Lia are the refugees given shelter in Laos by CIA. They belong to the large Hmong community in Merced. The Hmong people find it most difficult to assimilate in the mainstream culture of America with their subtle and rigid religious systems. The American doctors of Lia, Neil Ernst and his wife Peggy Philip try their best to treat the girl but in vain. It is classic case of miscommunication between two cultures that has taken the life of an innocent girl.
Lia’s parents and the doctors wanted to do the best and save the girl, but in their own ways which are diametrically different. The treatment for the girl becomes impossible as the Hmong parents consider the seizures as the signs of spirit visiting their daughter. The American doctors diagnose that as epilepsy. The doctors are concerned with the physical body of Lia, whereas her parents consider it in realms of spirit. The language being the greatest barrier between the two creates a gulf of misunderstanding and miscommunication. Lia becomes a helpless and poor victim to the communication gap. Thus, the story of Lia highlights the serious communication barrier between the doctors and the Hmong patient and clearly exposes the need for cross cultural understanding and training for the medical professionals.
2. Body- in several paragraphs, describe a part of the book and explain how that part shows your opinion is right (proves your main point). Discuss three parts of the book, summarizing the part and then explaining how it supports you opinion (main point)
The very title of the book is a literal translation of the Hmong phrase qaug dab peg, which means ‘a seizure.’ (p.20) The Hmong parents consider it a special indication for reverence for their child as it is considered purely a matter of religious importance. The seizures are considered the visits of the Spirit according to their culture. The doctors felt the seizures are due to misfiring of cerebral neurons. Lia’s parents call it the spirit catches you and you fall down. The gap in understanding of each is phenomenal. When one prescribed medicines the other prescribed sacrifices of animals.
The author, Fadiman has brilliantly presented the two cultures which take a totally contradictory view of Lia’s condition. It was considered great and something special in Hmong culture, just as it was treated with respect even by the ancient Greeks who regarded epilepsy as a sacred disease. (p.28) Lia’s parents consider this as a matter of spirit and they are totally unwilling to interfere in the matters of spirit. However, Lia’s parents were not totally indifferent to the health of their child. They brought her to the hospital and sought for doctors’ help. There is an internal struggle and conflict in their minds as to what course of action they should be taking in this matter being cut off from the land of their culture.
The miscommunication takes place almost at every juncture of the story. It begins with the very beginning of the story. In the fourth chapter, it is described how the misunderstanding about the American physicians started cropping up in the minds of the Thai people when they land up there. They also inquired about the availability of their traditional medicine txiv neeb. They could not understand why the American physicians took blood samples from the body and operated the patients, when the sickness is totally belonged to the spiritual realms. It was totally disagreeable for them how one man can cut the body of another. They were too suspicious to believe the American physicians. They wondered what the doctors could do with the body parts that have been taken from the patient. The diametrically contrasting views in the area of sickness and medicine put the two cultures juxtaposed. The physicians based their treatment by touching the patients which is beyond the comprehension of the Hmong people. However, the Hmong people understood the value of medicine and in the absence of their traditional medical methods in America; they approach the American physicians for treatment.
The next chapter illustrates how Lia was admitted to MCMC nearly seventeen times before she reached four and half years. Lia was observed and treated by the hospital doctors and nurses. But they could not understand what the parents of Lia were telling. The utter communication gap is felt and the doctors find themselves in quite helpless condition. They simply rely on their observation of the patient, as they could not follow the description of Lia’s parents. In the absence of a translator, Lia was given a veterinary treatment. The Hmong parents were asked to sign on the papers which they don’t understand. They were given the prescription of medicines and how they should be given to the patient, which they never followed properly. Thus, the communication gap severely impaired the treatment of Lia.
Contrary to the physicians inability to understand the patient’s condition, Lia’s parents understood her condition perfectly well. They even know from their daughter when the convulsions would start. They took every care before she would fall on the floor when the seizures attack her. They were very affectionate towards her, they cuddled her a lot, they would place her on a soft mat when they suspect she would fall down. But only one thing differentiated them from the doctors. The Hmong people always considered that it was purely a matter of spirit and not a physical thing. However, the increasing number of frequency of seizures panicked both her parents and doctors.
The following passage throws light on how the Hmong people considered the case of Lia and what they felt about the doctors.
Lia’s father said, “Sometimes the soul goes away but the doctors don’t believe it. I would like you to tell the doctors to believe in our neeb [healing spirit] … The doctors can fix some sicknesses that involve the body and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb, but not too much medicine because the medicine cuts the neeb’s effect. If we did a little of each she didn’t get sick as much, but the doctors wouldn’t let us give just a little medicine because they didn’t understand about the soul.” (p. 100)
It reflects the Hmong point of view of the disease that Lia is suffering from. Though the physicians prescribed medicines and asked Lia’s parents to administer the drugs, Lia’s parents did not follow it. They did not administer the medication partly because they did not understand how to give the medicine as they did not understand what the doctors told because of the language problem. It was also partly because of their opinion that so much medication was not necessary for her as it is a spiritual matter.
The doctors can not be blamed for the lapses in the treatment. They felt frustrated because of their inability to understand the feelings of Lia and her parents as they could not communicate with them properly. They felt they were practicing ‘veterinary medicine’ on Lia.
In spite of the best of efforts of the doctors, Lia was either under-medicated or sometimes mis-medicated and at times over-medicated. The doctors’ intense desire and sincerity can be well understood by their commitment to give her the best treatment. The following passage gives us a fair idea about how they felt about it. One of the doctors expresses:
“It was so haunting. I started to have nightmares that it was going to happen, and I would be the one on call, and I couldn’t stop it and she was going to die right before my eyes.” (p.118)
The physicians suspect that the grand mal seizure would further complicate the things. Rightly as they as they suspected, her condition deteriorated further to the anxiety of both her parents and the physicians.
Lia continued to suffer from seizures, which became worse in nature. After years of uncontrollable seizures, Lia regressed. She lost her ability to speak and interact with people. An especially bad episode of seizures rendered her brain-dead and paralyzed. The book delves into the question of who was to blame—the doctors who could possibly have saved her with their western medicine but didn’t, or her parents who were unable to understand the doctors’ directions. The book examines this issue but makes no conclusion. Instead, it uses Lia’s case as a study in anthropology and makes an argument for the inclusion of cross-cultural training and empathy in medical school as well as increased presence of interpreters and social workers in medical settings.
The Spirit Catches You and You Fall Down, is a valuable study of cross cultural medicine. Anne Fadiman has answered the most frequently posed questions about the Hmong. Among the scholarly studies and personal stories recorded and published within the last two decades, this heart-wrenching account reaches most deeply into the hidden crevices of the still wandering Hmong soul. This book is a basic guide for those who are interested in, or work with the Hmong.
3. Conclusion- restate your opinion and main reasons why it is correct. Elaborate on your point: you saw this and have an opinion about whats going on in the book, what else does it make you think about?
It exposes the need for understanding of cross-cultural values and belief systems.
Lia is the fourteenth child of Hmong Family, Noa Kao and Foua the father and mother of the child respectively. Lia is a patient of what the American doctors call epilepsy. However, the sudden seizures were believed to be the indications of great reverence the girl deserves according to Hmong belief system. The story of Lia
The Spirit Catches You and You Fall Down is the story of a Hmong Family, the Lees, their journey to America, and their struggles following their immigration. The Lee family were political refugees fleeing their home country of Laos in response to the “Silent War” and the subsequent loss of livelihood and starvation its inhabitants faced. The parents, Foua (mother) and Nao Kao (father), traveled through rough terrain and literally dodged the bullets of political enemies to bring their twelve children to safety in a refugee camp. While at the refugee camp, Foua delivered their thirteenth child. They were then relocated to California, a place chosen not by the family but by the US immigration officials who were trying to evenly spread the great number of immigrants across the country. While in America, Foua delivered their fourteenth child, Lia.
Unlike all of her previous births, which occurred at home in a peaceful setting, Lia’s birth occurred at Merced Community Medical Center (MCMC), because that was what the Lees mistakenly believed was necessary to obtain citizenship for their daughter. At her birth, Lia appeared to be a healthy, eight pound seven ounce girl and the delivery was uncomplicated. However, in infancy, Lia was diagnosed with what American doctors called epilepsy, a physical disease of the nervous system. In the Hmong culture, seizures were believed to occur in a spiritual realm and symbolized a condition deserving of reverence. According to their beliefs, Foua and Nao Kao thought that a spirit known as a dab had captured Lia’s spirit and wouldn’t return it. Their difference in belief systems as well as the language barrier prevented proper communication between the Lee family and their physicians. Over time, the doctors became exasperated and at times apathetic. The Lees also complained of feelings of frustration, as well as being misunderstood and blaming the doctors for intervening in ways that appeared to make Lia more sick instead of better. In a final insult, the doctors recommended Lia be removed from her parents’ home and placed in foster care because her parents were unable to read the English directions on her prescription bottles and Lia was not taking her anti-seizure medication according to the prescribed schedule.
