Cross-Cultural Misunderstanding in Anne Fadiman's In the Spirit Catches You and You Fall Down

The memoir, The Latehomecomer, written Kao Kalia Yang, presents the oppression and persecution of the Hmong people. Yang is a Hmong woman, who was born in a Refugee Camp in Thailand. Since then, she moved to the United States, graduated from Columbia University and wrote The Latehomecomer. Her book gave her audience a glimpse into the not as recognized topic, the history of the Hmong people, when Laos by Laotian and Vietnamese soldiers forced them out of Laos and into the United States. She wants people to know the harsh times of the Hmong people, and let the future generations of Hmong know what their ancestors had to endure. Yang

In a profession such as nursing, being aware of diverse cultural practices can help individuals provide the best care possible. According to Larry Purnell, there are twelve domains pertaining to culture that can define how unconsciously or consciously we are either competent or incompetent. These domains include heritage, communication, family roles, workforce, bicultural ecology, high-risk behaviors, nutrition, pregnancy and childbearing, death rituals, spirituality, health care practice, and health care practitioners. To expand my knowledge on these domains pertaining to Filipino culture, I interviewed Joseph A. His mother emigrated to the United States over 25 years ago from the Philippines, and has ensured that their family stays true to many Filipino traditions, including speaking their native language of Tagalog at home.

Many live under the assumption that those who come to the United States want to become Americanized and assimilate to the melting pot our culture has formed into. This is the populations ethnocentric belief, which is the belief that the ways of one’s culture are superior to the ways of a different culture, that wants others to melt into the western ways. In Ann Faidman’s The Spirit Catches You and You Fall Down, Faidman fails to completely remain objective when demonstrating how cross-cultural misunderstandings create issues in the healthcare field, specifically between the Hmong and western cultures that created dire consequences between the Lee’s and their American doctors. Faidman uses her connections with the Hmong and the doctors who cared for them in order to disclose the different views, beliefs and practices the Hmong and Western cultures practiced. With her attempt to be culturally relative to the situation, Faidman discusses the series of events and reasons as to why the Lee’s faced the fate that they did and how it parallels to the ethnocentrism in the health care system.

On the other hand, western medicine doctors diagnose the problem by observing the physical symptoms, screening the blood, and perform various other medical techniques that rely on advanced medical education and training. Doctors are concerned with the physical symptoms and disregard the “soul” which in turn conflicts with the Hmong culture because they believe in souls and higher mental processes. Fadiman’s proved that the central argument was the collision between the Hmong culture and the physical disease treatment of western medicine.

Social scientists believe that there are anywhere between six and seven million Hmong around the world. The Hmong never had a country that they could call their “home” country and to this day this is still the case. Until relatively modern times, the majority of the Hmong people resided in the mountains of Southern China, Laos, Thailand, and northern Vietnam. As an ethnic group, the Hmong are fascinating in this sense. Today there is a large Hmong population in the United States. However, unlike a majority of the other Asian American communities present in America, the Hmong reached American soil through much difficulty and hardships. As observed in the experiences of many other immigrant groups, becoming a part of American society is not an easy task. In order to understand the circumstances of Hmong Americans today, one must comprehend the different political, economic, and social pressures that may have aided or hindered these people’s integration into American society. The first part of my paper will consist of a brief background of the Hmong. Grasping the background will allow for a thorough analysis of the reasons for Hmong immigration and the issues that they may have faced attempting to establish their own individual identity in the United States.

Introduction The Spirit Catches You and You Fall Down, by Anne Fadiman (1997), is a book that details the complicated journey of Lia Lee and her family, who were Hmong refugees living in Merced, California. Lia had a severe form of epilepsy that caused her to have many hospital visits and interactions with the health care system, where she received subpar care because of the language and cultural differences between the health care providers and her Hmong family. This paper will identify one social issue illuminated by Fadiman's (1997) case study and suggest one practice and one policy change at each of the micro, mezzo, and macro system levels. Furthermore, each social issue and corresponding practice and policy change is tied to the central

The Hmong, an Asian ethnic group, came from an oral culture, where they did not have any written form until the 1950s (McCall, 1999). The Hmong lived an agricultural lifestyle in the hill and mountain areas in Laos, Vietnam, and Thailand (McCall, 1999; Tatman, 2004). They focused on physical labor to provide food for the family and lacked formal education, as it was not essential (Lee & Green, 2008; McCall, 1999).

“It felt as if there was this layer of Saran Wrap or something between us….So we couldn’t really accomplish what we were trying to do, which was to take care of Lia” (47-48). The cultural barrier between Lia Lee’s parents and the medical staff at Merced Community Medical Center (MCMC) was recognized equally by both parties throughout the many interactions they had. From Lia’s birth to her final release from MCMC a recurring theme has been reproduction, specifically its difference between Hmong and American traditions. The several occurrences between pregnant Hmong women and the medical staff at MCMC are demonstrative of the language and custom barriers between the two cultural groups. Standards of parental care are also different within the two cultures and both Hmong and American standards affected Lia’s health. Emotions and understandings towards children born or obtaining disability had both parties treat Lia differently throughout her varying stages of being medically treated. The different cultures pertaining specifically to reproduction are main factors that shaped Lia’s overall medical treatment through miscommunication, varying standards of parenthood, and viewpoints towards disability.

The Spirit Catches You and You Fall Down is only one example of many that shows how cultural differences affect health. Cultural differences such as variations in beliefs, preferences, behaviors, recognition of symptoms, and expectations of care because of one’s culture, are some factors that influence decision making and consequently, health outcomes.2 For example, the Hmong’s cultural beliefs include respecting the patient’s privacy by not asking personal questions, asking them to undress, or take blood samples,

Over a period of time, the Hmong people have immigrated from country to country due to oppression from governments and due to their involvement in wars. For this reason, Hmong people are now found living scattered across the globe (Tatman 2004). With no country to call home, they fled to the hillsides and mountain tops of nearby neighboring countries. As a result, the Hmong people had to reestablish their communities and families wherever the settled. Although the Hmong’s lacked a formal government and a central leader, Hmong families were often lead by a dominant male figure within the family who was responsible for the decision making and wellbeing of the group (Long 2008). The social structure found within Hmong communities and Hmong

Hmong involvement in the Vietnam War led families like the Yangs to immigrate to the United States. Yang was born in a refugee camp in Thailand, (Yang, pg. 53). Like some Hmong families, she was relocated to the United States. Yang was considered lucky because many other Hmong families were left behind in a country that considered them traitors, (George, 2010).

For my Religion Research Project, I decided to research the religion of Hmong. To me the Hmong religion is very interesting and I have always wanted to know more about them. The Hmong people were believed to have come from the Yangtze River basin area in southern China. They were originally known in China as the Miao. These days there is debate on the usage of that name by Hmong in the west because they believe it to be derogatory, even though it is still used by the Hmong in china to this day. It is said by Chinese scholars that the Hmong people were a proud and independent people. The history of the Hmong people is hard to trace, they have their oral traditions but there are no written records of them.

The Hmong people, who fled the country of Laos when communists took over, are people of many cultural

The doctors shouldn’t have the Lees’ family feel that their beliefs and traditions weren’t being valued. The collision between Lia’s demise wasn’t because of it about the Hmong vs the U.S. but the tension between Hmong culture and U.S. medicine. Nevertheless, Some doctors do believe that there will never be enough training to better prepare them for being culturally sensitive to everyone. They say that there is not enough time in their already busy schedules to be culturally sensitive all the time. But Fadiman would argue that cultural sensitivity is significant because it plays an extreme and crucial role in helping to make healthcare more effective and appropriate for all patients, from all cultural backgrounds.

Medical anthropology looks at health across all culture and how health is affected by culture. This is a different perspective then what medical practitioners are trained in medical school, which is they are focusing on looking for the disease and treating it. When it comes to a person’s health and treatment it is hard for a medical practitioner to consider all of the possibility that could play role in a person’s illness and/or disease. The medical practitioner does their best to find the disease and treat it as fast as possible (due to the volumes of patients that they have to see), but that is not always the best thing for them to do. There are other factors that could play an important role in the patient’s illness and/or disease and that the medical practitioner should take time to listen and talking to the patients to get the full story. In this paper, I will talk about the importance of culture in understanding health, the “cultural competency”, and others factors that influence health.