The Spirit Catches You and You Fall Down by Anne Fadiman Essay

In addition, relying on a doctor who does not share the same beliefs as one does can become fearful. Trusting the doctor for full treatment is necessary but when from a different cultural background it can prevent them on trusting them. According to a research article, Cross- Cultural Medicine a Decade Later, clearly states “when the basic belief structure of biomedicine and another set of health beliefs differs radically, problems and frustrations almost inevitably arise” (Barker, 1992, p.249). The central purpose of the research was to show whether or not health beliefs between patient and doctor differs will they find it difficult to interpret the symptoms and treatment variations to accommodate their beliefs. However, the doctor having faith in one’s health beliefs can sometimes be beneficial for the patients because they’ll be fully understood and not misjudged as being crazy. As stated by the author, for the article Chinese Health Beliefs of Older Chinese in Canada, “the findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intergroup socio-cultural diversity that health practitioners should acknowledge in their practice” (Lai, 2009, 38). Like the Chinese, Hmong’s too first go to their shaman for traditional treatment rather than going to the doctor; to them an illness and their healing is more of a spiritual thing that

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 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.

Kind of like in the book “the spirit catches you and you fall down,” by Anne Fadiman. Fadiman described how the Hmong’s and the doctors had different point of views; because of their differences in culture and the language barrier they had trouble communicating and understanding one another. In the Banes family, Jackie was responsible for understanding and pursuing treatments for her grandmother. These treatments were not so easy for Jackie to understand, and often there has been a lack of communication

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

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.

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.

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

The case study of Lia Lee is interesting and serves as a cautionary tale as it explores the consequences of cultural misunderstanding. In this case both the parents and medical staff sought the same thing; they both wanted Lia to have a positive outcome. Unfortunately, both groups had distinct ideas regarding how to achieve the common objective. This division was rooted in each sides individual cultural beliefs.

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

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.

“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.

“The Spirit Catches You and You Fall Down” by Anne Fadiman presents the story of a Hmong child and her family and the obstacles that they face through her battles with epilepsy. The story takes place in Merced, California and centered around the Merced Community Medical Center. The Hmong child is Lia Lee and her parents are Nao Kao and Foua Lee. The parents of Lia did not understand English nor do they speak it which caused a lot of confusion and commotion among the staffs as they tried their best to explain what the situation is and procedure that they should follow to treat Lia. Throughout the course of the book, the author also dedicated a few chapters to the history and culture of the Hmong people.