The Spirit Catches You and You Fall Down

I feel that Anne Fadiman narrated the story of Lia Lee’s and her family’s life in intimate and tragic detail. The Spirit Catches You and You Fall Down is a poignant depiction of the struggle between loving parents, hard-working medical professionals, and a very precious child caught in the middle of a tug-of-war. Ms. Fadiman very distinctly illustrates how the collision of two cultures indirectly led to the demise of a little seven- year old girl.

Directions: Read the captioned book. Then answer the questions contained in this study guide. Post your completed document to the appropriate assignment box on the course website.

The Spirit Catches You and You Fall Down, portrays two themes. First, the text refers to Hmong history and the destabilization of the region of Vietnam forcing Hmong refugees to migrate to other parts of the world but mostly the United States. Within the text is another story of a Hmong refugee family and their daughter named Lia Lee who settle in Merced California. Lia is tormented by a misfortunate diagnosis of epilepsy and faced by cultural inequality by her American doctors. Health care providers wrote Lia Lee off as a complex patient with severe communication barriers. Almost all of her admission notes contained the phrase” language barrier” (Fadiman, 2012). As she bounced back and forth between healthcare providers within the Emergency Room and pediatric visits, her doctor, Neil Ernst concurs that her parents are responsible for the communication barrier and non-compliance with prescribed treatment. Dr. Ernst deemed this as neglect and had Lia placed in a foster home but after being separated from the only people she knew, her conditioned rapidly deteriorated. Her seizures progressed in intensity and duration until one

The Spirit Catches You and You Fall Down or quag dab peg is said to mean “a soul stealing dab; peg means to catch or hit; and quag means to fall over with one’s roots still in the ground, as grain might be beaten down by wind or rain” (Fadiman, 1997). The Lee family belonged to the Hmong tribe, which was the basis of their differing beliefs in comparison with modern medicine. Lia’s parents believed that when she was three months of age, she had been startled when her older sister, Yer, slammed the door of the Lee family’s apartment. This resulted in Lia’s first seizure which her parents believed made Lia particularly fit for divine office. The Hmong believed epileptics became shamans or medicine men and

I have learned that it is important that educators  and health providers be trained on cultural competency to understand the population they are serving. Marks, Sims, and Osher (King, Sims, & Osher, n.d.) define cultural competency  as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross–cultural situations" ( as cited in Cross et al., 1989; Isaacs & Benjamin, 1991). Health providers and educators should investigate demographic patterns or trends in the place where they live and work. This brings awareness of the types of cultures that they might come across when they are working with people. Organizations should integrate and implement policies that promote the value of  diversity, self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of communities they serve (Georgetown  University, 2004). Georgetown University (2004) also stresses that culture competency grows gradually and is always open for improvement.

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

Structural Causes of Cultural Insensitivity in Anne Fadiman’s The Spirit Catches You and You Fall Down

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.

1. Do you think the author was evenhanded in her presentation of Hmong culture and medical culture?

“In the Spirit Catches You and You Fall Down”, Anne Fadiman explores the subject of cross cultural misunderstanding. This she effectively portrays using Lia, a Hmong, her medical history, the misunderstandings created by obstacles of communication, the religious background, the battle with modernized medical science and cultural anachronisms. Handling an epileptic child, in a strange land in a manner very unlike the shamanistic animism they were accustomed to, generated many problems for her parents. The author dwells on the radically different cultures to highlight the necessity for medical communities to have an understanding of the immigrants when treating them.

In The Spirit Catches You and You Fall Down, there are many different intercultural misunderstandings. A Hmong girl’s life was forever changed because of these misunderstandings and some things could have easily been avoided, had each side taken the time to better understand the other.

The book titled The Spirit Catches You and You Fall Down: Talks about a Hmong Child, Her American Doctors, and the Collision of Two Cultures written by Anne Fadiman. Anne Fadiman is an American essayist and reporter, who interests include literary journalism. She is a champion of the National Book Critics Circle Award for Nonfiction, the Salon Book Award, and the Los Angeles Times Book Prize for Current Interest. In the book, Anne Fadiman explores the clash between a county hospital in California and a refugee family from Laos over the health care of Lia Lee. Lia Lee is a Hmong child diagnosed with severe epilepsy, whose parents and the doctors wanted the best treatment for her, but the lack of communication cause a tragedy. The essay paper will state and explain what went wrong between Lia’s family and the doctors. The central point is a lack of understanding between them leads to Lia’s tragedy.

The first step to achieving complete cultural competency is valuing diversity. It is a process that requires cultural humility. Unlike competency, cultural humility goes beyond simply being knowledgeable of differences, but having a humble desire to ensure a lifelong commitment to intercultural exchange (Tervalon & Murray-Garcia, 1998). I have witnessed some Americans oppose the idea of immigration and strongly believe that American services should not cater to immigrants. They believe that all foreigners should learn English and the United States should not accommodate their linguistic needs. These same people are aware of the cultural differences that exist in America, but lack cultural humility and appreciation for diversity, making it difficult for them to attain complete cultural competency. A public health professional cannot go into a community, assuming that everyone thinks and behaves like them. They must be open-minded, flexible, empathetic, and aware of the differences and similarities that exist. Therefore, cultural humility is a prerequisite in achieving cultural competence.

I have to admit when I first read “The spirit catches you and you fall down” I thought it would be pretty boring turns out its one of the most interesting books I have ever read. The cultural conflicts can apply to anyone and knowing a little bit more now what the Hmong people have actually gone through can make everyone develop a great amount of respect for the culture. The Lee family continuously went full force colliding with the American ways in order to protect their traditions so they could preserve their culture. Unfortunately, in the end it didn’t help them but that was all they knew considering the fact that that the doctors at MCMC hospital didn’t really go out of their way to explain procedures it only makes sense for the Lee family to revert back to what they know in their traditions.