The Spirit Catches You And You Fall Down Analysis

Dr. Neil intended for Lia to become healthier when taken away from her family because she could then live with a family who would follow her medical regimen. However, this proved to be not as effective as he thought. Lia’s seizures were a little more controlled because of her adequate medication levels, but soon after her seizures had become worse and caused developmental deficits. The Hmong community was upset about what had happened. They did not learn what Dr. Neil wanted them to. In their eyes they saw that the medications and the hospital made Lia even sicker. The Hmong’s now distrusted doctors even more. They Lees thought the doctors took her away because they were mad at them for not giving her enough medication. They did not

Language barrier was a major factor that served to extend the boundary existing between the two cultures. Some of the utterances made by the doctors were interpreted right but were understood wrongly (Swartz 2). This resulted in a worsened discernment of the American doctors by the Lees and Hmong as an entity alike. In the case of an emergency, the Lees needed to contact an ambulance, but could not communicate with the hospital. This necessitated the involvement of their learned nephew, who would call an ambulance. The interpretation process would at times limit the effectiveness of the message intended by either party. For instance, when Lia was undergoing critical care in MCMC, the Lees needed to be comforted, a process which had to be done by an interpreter. Before the final discharge, miscommunication between Lia’s mother and the doctors had her think that the nurses disconnected medicine tubes off Lia in order to give it to some other patient; a mean act. In the same incident, Lia’s father was made to sign a letter of discharge for Lia, which would happen in two hours. However, he understood this as a letter to guarantee death in two

     The Hmong had trouble adapting to American life. With no driver’s license or bank account, they had to make a living doing whatever they could. Not knowing the language in a foreign land doesn’t help either. The Hmong women adapted much more quickly than the men did because of the fact that they interacted more with English-speaking people. While the men were at work, the women were spending time interacting. The Hmong men also refused to change more that the women did. This shift of power caused a lot of changes in Hmong households. What even caused more of a power shift was the fact that the Hmong children learned about the culture easier than the women did. Instead of the father having control over the family like it was back in Southeast Asia, the children now had the upper edge. The children could communicate, interact and even drive with Americans. You could see a 16-year-old Hmong

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.

This prejudice is another strong concept, as the American doctors continued to underestimate, disrespect, and undermine Foua Yang (mother) and Nao Kao Lee (father) and their Hmong way of life. Vice versa, the Lees would refuse doctors’ orders in administering medicines. Ruane and Cerulo hit it right on the nail when describing prejudice,(20) which is a prejudgment directed towards members of certain social groups, as a feeling associated with immigrant groups, those that contain individuals who have left their homelands in pursuit of a new life in a new country. There is a clear indication of an in-group vs. an out-group, as it is noted from Second Thoughts, “an in-group carry unrealistically positive views of their group. At the same time…share unrealistically negative views of the out-group.” The cultural barriers are built due to “the one-sided relationship,” of knowledge only found in the unyielding West, with the prominent racial discrimination found among the white, English-speaking doctors and their intimidate dismissal of the existence of any Hmong medical practices/knowledge. The application of assimilation (20) is important to the in-group, as they simply believe that the immigrants will come to embrace the same values and customs of their new ‘homeland.’

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

Many years ago, an epileptic Hmong girl named Lia Lee entered a permanent vegetative state due to cross-cultural misunderstanding between her parents and her doctors. An author named Anne Fadiman documented this case and tried to untangle what exactly went wrong with the situation. Two key players in her narrative were Neil Ernst and Peggy Philp, the main doctors on Lia’s case. As Fadiman describes, “Neil and Peggy liked the Hmong, too, but they did not love them… [W]henever a patient crossed the compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle.” (Fadiman 265) At first glance, this statement seems to implicate Neil and Peggy as morally blameworthy for a failure to be culturally sensitive enough. However, upon further inspection of the rest of the book, it becomes clear that Neil and Peggy’s failure to be more culturally sensitive to their Hmong patients was caused by structural issues in the American biomedical system. To prove this point, this paper will first present a background to Lia’s case, then discuss possibilities for assigning blame to Neil and Peggy, then show evidence for the structural issues in American biomedicine, before finally concluding.

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.

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive, yet problems do arise and it affects the quality of care the patient receives. Language barrier, poor socioeconomic status, and poor health literacy also contribute to health care disparity. For Lia, it was more than her skin color, it was all of the above, her parents did not speak English and they were illiterate. They had trouble understanding the American healthcare system, had trouble or little interest in adjusting to or understanding the American culture. They didn’t work, which in addition to cross cultural misunderstanding, helped contribute to animosity between the Hmong and the host community, because some in the Merced area did not like or appreciate the fact that some Hmong did not work and relied on welfare to make ends meet. All these factors, contributed to the poor quality of

In ‘The Spirit Catches You And You Fall Down’, Lia, a Hmong baby girl, is born to a Hmong family living in California as refugees away from their war torn land in Laos. In Laos the Lee’s where farmers and lived in the country according to their Hmong traditions and beliefs. In California they barely understood the language, much less Western culture or medicinal practices. In Hmong tradition, illness was seen as a spiritual problem rather than a physical problem and a Shaman that practiced spiritual ceremonies and used natural remedies was sought to prevent or cure certain illnesses and/or diseases; so when Lia suffered her first seizure at the age of 3 months and was taken to Mercer

“…you can miss a lot by sticking to the point” (Fadiman 13). The Hmong is a proud group that withstood a long history of trials and tribulations. Throughout these hardships, they managed to keep their customs and cultures alive, even in the face of adversity. This adversity had many faces. The Spirit Catches You and You Fall Down shows us this in the form of healthcare.

In addition, Laotians also have differences in expectation of involvement of elders in healthcare decisions for family members, limited health literacy and preferences for herbal medicine and Shaman rather than Western medicine. Never the less, I feel that I have seen a change in the moral values and cultural norms in the United States over the past twenty years. It is difficult to determine whether this is related to a shift in values, the influx of immigrants with a different value system or simply a sign of the

Even though there is a slight gap between acculturation, the younger groups still maintain their traditional Hmong lifestyle that their ancestors withhold by attending Hmong New Years, weddings, speaking the native language and eating Hmong food. Most parents aren’t accustomed to their children’s lifestyle and create fear that their children will completely disregard their Hmong heritage. Most adolescent to younger adults identify themselves American compared to their parents because they were born in America and been exposed to institutionalization. While their parents are still holding on to Hmong cultural beliefs and values, they feel as though it doesn’t apply to them.

Once discovering that the Lees are illiterate, it should be obvious that they would not know how to follow directions; yet even if there is some understanding, there is no guarantee that Lia’s parents will agree to follow the Western doctor’s prescriptions. Throughout the novel, the Lees often make decisions of prescription based on how the medicine affects Lia’s spirit and if the treatment conflicts with Hmong spiritual belief. The inconsistency by which Lia’s parents follow or disregard medical instructions both angers and frustrates the Western medical doctors by slowing down their ability to heal Lia with Western medicine. Being asked to follow Western practices to heal their daughter, the Lees abide by Hmong culture in the refusal of orders

Picture this – the setting is post-Civil War in the United States. Millions of Americans risked their lives and shed blood to bring slavery to a halt. Millions of Americans lost their husbands, fathers, sons, nephews, friends in this intense war. Yet all this sacrifice was still not able to stop the subtler matter in the war – racism. Why would it matter? Just because the government took away slave owners’ properties doesn’t mean the government can take away their thoughts, opinions, and beliefs. It’s part of free speech, protected by the first amendment. Well, when those thoughts, opinions, and beliefs impede others’ rights, that’s when it becomes an issue – an issue like segregation. This issue not only affected African-Americans, but immigrants looking for a new life. With help from Mae Ngai’s book The Lucky Ones, the controversy of segregation can be analyzed through the lives of two Chinese immigrants, Joseph and Mary Tape, and their efforts to assimilate into American culture. Although there were some American citizens at the time that had good relations with non-white immigrants, the Tapes’ story reveals how racism against those who did not fit the "common white-American" phenotype denies the Tapes’ genuine acceptance in the United States - either as members in the community or as naturalized citizens of the country.