Fadiman Case Study: the Spirit Catches You and You Fall Down Essay

In Hmong’s, they have their own traditional beliefs in which they hardly ever alter due to a different atmosphere. Some of the Hmong beliefs are they prefer traditional medicine, are culturally active, host ritual ceremonies, and are spirituality influenced. In the book The Spirit Catches You and You Fall Down, refers to the Hmong culture and their beliefs on medicine while their baby Lia Lee, is suffering from epilepsy in which they have a hard decision. Traditional Hmong’s have their own medicinal beliefs which they obey prior to obtaining Western medicine. The gulf between Western medicine and Hmong health beliefs is an impossible abyss. Also, The Spirit Catches You and You Fall Down describes the life of Hmong refugees assimilating to

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.

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

The Spirit Catches You and You Fall Down is the story by author Anne Fadiman, which explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia’s parents and her doctors both wanted what was best for Lia, but the lack of communication between them led to tragedy.1The lack of communication due to cultural misunderstanding, mistrust, lack empathy, and poor health literacy led to care being comprised for Lia, which also affected both her parents and healthcare providers.

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.

The Hmong cultural/religious belief in shamanistic animism claim that wicked spirits are continually searching human souls, mostly those of defenseless or unappreciated children. For Hmong culture, epilepsy is known as qaug dab peg which means, "the spirit catches you and you fall down" in English (Fadiman 1997), which epileptic invasions are seen as affirmation of the epileptic's capability to enter and stay temporarily into the spirit world (unconsciousness). In Hmong

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.

Today, doctors call it epilepsy. According to the author, the sacred disease got its original name from “witch-doctors, faith-healers, quacks, and charlatans” (2). The name holds some form of religious or superstitious value since it includes the word ‘sacred’ in the title of the disease, yet “it has been regarded as a divine visitation by those who, being only human, view it with ignorance and astonishment” (1). He quickly dismisses the idea that this disease is sacred by any manner and chalks it up as a hoax by the witch-doctors to make themselves seem more pious and religious, which ultimately increases their false reputation as trustworthy people. He attacks his enemy by criticizing their character and making his medical belief appear more reliable and relevant. Within the first couple paragraphs of The Sacred Disease, the author debunks the origin of the name as ‘sacred’ by attributing it to ignorant people and fake physicians of society. The author questions the divinity in the name of this particular disease; wondering why it deserves such a title, and continues to comment on the un-remarkability of other ‘non-sacred’

Epilepsy was not always known to be a medical issue. Epilepsy was thought to be caused by spirits, demons or divine experiences, like many cultures such as the Hmong believed (they still do). The first occurrence of epilepsy being considered a medical issue

The ‘sacred disease’ has another name according to the medical practices of the twenty-first century. Today, doctors call it epilepsy. According to the author, the sacred disease got its original name from “witch-doctors, faith-healers, quacks, and charlatans” (The Sacred Disease 2). The name holds some form of religious or superstitious value since it includes the word ‘sacred’ in the title of the disease, yet “it has been regarded as a divine visitation by those who, being only human, view it with ignorance and astonishment” (The Sacred Disease 1). The idea that this disease is sacred by any manner is quickly dismissed as a hoax by the witch-doctors to make themselves seem more pious