Anne Fadiman Epilepsy Case Summary

Lia is born of a loving Hmong family, and just three months into her life, begins to reveal epileptic symptoms. According to the Hmong community, the condition is curable, and the presence of spirits in such a patient’s soul is considered a blessing. However, American doctors in a community medical center fail to understand and appreciate Lia’s parents’ approach to the child’s disease, and are only interested in saving this child’s life. As the conflict develops, it becomes apparent that the child will not be healed; but this is not without the doctors realizing the importance of compromise. In this book, Anne Fadiman claims, “I have come to believe that her [Lia’s] life

The doctors assuming the Lee were giving their daughter her medications, were surprised to not see levels of the medications in her blood. Dan Murphy who was one of Lia’s doctor questioned the parents and he learned that due to their cultural beliefs, Lia’s parents have not been administering her with the proper medicine. Where Lia’s mother believes she is doing the right thing for her daughter, Murphy has sympathy for the mother and told Fadiman “I remember having a little bit of awe of how differently we looked at the world”. A key feature of the Hmong is that they have no interest in being rule, do not like to be told what to do, and are rarely persuaded by the customs of other culture. The mistrust and open hostility between the medical staff and the Lee family seemed to overshadow Lia’s disease. Both side obviously loves Lia and wants her healthy but neither was willing to compromised and meet half way.

With the loud noise of a slamming door the family believed that Lia’s spirit had been frightened and left the body causing the sickness she was experiencing. The family saw the seizures as an illness of some distinction. In the Hmong culture epileptics often become shamans. The chapter goes on to tell the child’s story about multiple trips to the Hospital Emergency Room. It speaks about the lack of communication surrounding the child’s symptoms. The family is unable, and the medical team unaware of the lack of communication about medical dosages. The doctors have no idea about parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects. The doctors do not attempt to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme.

The Spirit Catches You and You Fall Down (1997) is an ethnography written by Anne Faidman. It tells the story of Lia Lee, a Hmong girl with severe epilepsy, and her family’s journey with managing the condition and the cultural barriers that posed great challenges in Lia’s care. Lia was diagnosed with epilepsy at age 1. It was her family’s opinion that the condition was a spiritual gift. Lia’s parents, Nao Kao and Foua, were wary of the American medical system, preferring to treat Lia in the Hmong way. Under the more spiritually focused care of her parents, Lia continued to have severe seizures; at the age of 4 ½, she slipped into a coma that would last the rest of her life. This book serves as a testament to the importance of cultural competency

1. The client system, in this case the Lee family, defines Lia’s seizures as both a spiritual and physical ailment. According to Fadiman (1997), “…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’”(p.20). To the Lee family, Lia’s condition was as revered as it was frightening. While a person with qaug dab peg was traditionally held in high esteem in the Hmong culture, it was also terrifying enough that the Lee’s rushed Lia to the emergency room more than once in the first few months

The Lees, a Hmong family, came to the United States in the 1970s as refugees from Laos, and lived in Merced, California. Unlike most immigrants, the Hmong population was less amenable to assimilation. The traditional health beliefs and practices of the Hmong population were disputed by the practices of Western medicine. This became very event when the Lees took their three-month-old daughter, Lia Lee, to the emergency room in Merced. Lia was diagnosed with epilepsy a disease that had two different meaning among the Hmong population and Western medicine.

Comparing quag dab peg and epilepsy is all a matter of perspective. We can diagnose what Lia is going through as either a disease or a blessing, depending if our mindset is that of a MMC medical staff or a Hmong, respectively. Before I begin I must answer the question and say that all though both sides describe almost the same symptoms, it’s a matter of perspective, your red is not the same as my red. So no quag dab peg and epilepsy are not the same thing. For the Hmong having quag dab peg is a blessing. Yes they acknowledge that being quag dab peg is potentially life threatening but also quag dab peg means your body is considered clean enough for the “Soul of Health” to enter your body. They consider quag dab peg or “The spirit catches you and you fall down” a symptom associated with the highest levels of purity. For example, being quag dab peg means your body is clean enough for the healing soul to enter your body, since this spirit is never wrong in choosing the pure. A quag dab peg individual is considered a highly respected person in the community and is most likely candidate to become a Shaman. Being quag dab peg means you have the ability to go between both worlds say heaven and earth. In contrast, being epileptic as defined by the medical staff at Merced is a neurological disorder marked by sudden recurrent episodes of sensory disturbance. In conclusion, the Merced Medical staff want to cure the disease while the Hmong are grateful Lia is qua dab peg. To the Hmong

The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame

Lia Lee was a Hmong infant born with epilepsy. Lia’s parents were immigrants to a Western nation. However, the parents held tightly onto traditional beliefs from their native country. The incongruent belief structure of the East and West created difficulty when the two systems collided in an effort to care for Lia Lee. Specifically, when the drug therapy prescribed for Lia Lee was not followed by her parents. Subsequently the child’s medical team contacted child services, which lead to Lia’s removal from her family. The result of the cultural misunderstanding was fragmented family. In addition to fueling the distrust of the western healthcare system by an already marginalized community.

Native American traditional medicine and spiritual healing rituals go back for thousands of years, these traditions often focus on different variations of alternative medicine. This knowledge is passed on throughout generations, many of the tribes learn that by mixing natural plants such as herbs and roots they can make remedies with healing properties. It is believed that being healthy is when people reach a state of harmony not only spiritually, mentally but physically. To be able to overcome the forces that cause illness people must “operate in the context of relationship to four constructs —namely, spirituality (Creator, Mother Earth, Great Father); community (family, clan, tribe/nation); environment (daily life, nature, balance); and self (inner passions and peace, thoughts, and values)” (Portman & Garret, 2006, p.453). In this research paper I am going to show evidence of the tremendous influence that Native American medicine and spiritual healing have over modern medicine in the course of healing

We can see that there was a misunderstanding between the Lee’s and the doctor. Both parties explained the view on Lia’s case but from a biased perspective within their own culture. Lia's doctors strongly opinionated to treat her disease with medication, however her parents felt that being given medication would restrict with the spiritual healing given by a Hmong shaman.

One of the biggest hurdles between the Lee family and MCMC doctor’s was their variation of belief’s involving medicine and culture. Hmong’s are very spiritual people, often believing illness can cause soul loss.

I believe Lia’s epilepsy and her state of condition was so severe that by the time she got to the hospital there was not much you could do for her. If there was no language and cultural barrier between the Lee’s and the medical providers, Lia could possibly have gotten the help she needed to live longer but not alive. In the book, it states “If Lia had not had seizures, she would have presented in a coma and shock, and the outcome would probably have been the same, except that her problem might have been more easily recognized. It was too late by the time she got to Valley Children’s. It was probably too late by the time she got to MCMC”. This implies that Lia’s outcome would have been the same no matter what. Perhaps if there were never such

Guideline one knowledge of cultures was not met. An example of this guideline not being met in the ethnography was when a Hmong patient came to the Family Practice Center and complained of a stomach ache, what they were actually complaining of was “the entire universe was out of balance,” (Fadiman, 1997, p. 61). If the health care provider knew more about the Hmong culture he or she could have asked more questions to decipher what was truly going on in the patients life.

The primary belief system across Laos is that all individuals and objects have various souls. This animism, along with the idea of reincarnation and ancestral worship, has a direct link to their healthcare. Among the Lao populous spirituality is exceptionally connected to their views of illnesses. Either the sins of one have angered their ancestors, or one has lost a soul because of their misdeeds or actions. With a combination of natural and super natural causes, a Hmong individual believes illness can befall them. A list of common reasons of Lao illness is as follows: accidents, infectious disease, curses, spells, and any taboo violation. The Hmong believe so strongly that illness is caused by some supernatural cause, they may request a multitude of health services when visiting the US.