In this book review of The Spirit Catches You And You Fall Down: A Hmong Child, Her American Doctors, And The Collision Of Two Cultures, the account of a clash between two cultures, and the fate of a three year old epileptic Hmong girl will be discussed. The review cites the 1997 edition of the book published by Farrar, Straus, and Giroux. All references in the review are from this edition. The goal of this review is to outline several of the book’s strengths and weaknesses, to explain the reviewer’s opinion of the book, and to lay out how the narrative exemplifies (and challenges us to think about) key concepts in anthropology and ethnographic studies. Finally, the paper will point out how the story of Lia Lee has implications for one’s personal and professional roles.
The book is well written because each chapter focuses on a specific episode in Lia Lee’s life, while at the same time building suspense, and informing the reader of the many details that led to Lia becoming separated from her family, and the subsequent results of her treatment. Also, the book strives for objectivity, and was careful not to play a blame game. However, it lacked the subjectivity from the vantage point of the Lee family. Mary Louise Pratt in an essay entitled “Fieldwork in Common Places” mentions a similar problem, but she sees it as a good contradiction, because it is inevitable that subjective storytelling will be paired next to objective facts, but this pairing never yields a black and white answer (32). Culture is complicated. Because the book is not written from a Hmong perspective, much is lost in translation. Understanding that this is a huge problem, it should be noted that this is also a problem of anthropology in general. How do ethnographers translate the subjective experiences of the subjects they wish to interrogate, without clouding judgments with ethnocentric values and beliefs?
One strength of the book is the approach the author takes in telling Lia Lee’s story. First, Fadiman is a good researcher, and she supports the narrative with primary source documentation, interwoven nicely into the storytelling. For example, when Lia is first diagnosed with epilepsy by Neil Ernst, the reader is presented with his notes he took on her arrival, so it is possible to see in the evidence the problems of miscommunication that arose between the Lee family and her pediatricians. It is interesting, too, to see how the Hmong see epilepsy as a condition that can be controlled by supplicating spiritual forces, while the American doctors note an epileptic seizure is an “electrochemical storm insider [a person’s] head -- by misfiring of aberrant brain cells.
The strength of the story is how it makes us think about the concept of the divine. Fadiman cites the Fourth Century B.C.E physician Hippocrates who wrote
It seems to me that the disease is no more divine than any other. It has a natural cause just as other diseases have. Men think it is divine merely because they don't understand it. But if they called everything divine which they do not understand, why, there would be no end of divine things (29).
Thinking of epileptic seizures as communication with the divine is not an unusual interpretation, and as Collins mentions in his book Magic in the Ancient Greek World, it was common practice to interpret epilepsy as some kind of divine happening just because it is so extraordinary (37). Is it not too far fetched to think that behaviors that bring us to an experience of the divine is simply something that is prevalent across cultures?
Any primary source material from the Hmong side of the story is a translation, and of course, for readers of the book who are not Hmong, the documentation is filtered through an English translation. Of course, a translation is needed, but it would have been an added scholarly feature, to include primary source documentation in Hmong language, alongside the English translations. Instead, Fadiman’s translation is screened through her own explanation of the subtleties of the Hmong language. It is a weakness in method because it assumes that the audience for the book is a non-Hmong person, or a person who is not familiar with the Hmong language.
The idea of learning about culture as a way of interpreting experience came across in the story in several ways. First, the title of the book “The Spirit Catches You And You Fall Down” refers to how different interpretations are inherent in experience. From a “Western” perspective, the concept of spirit has a different connotation than the one intended in the phrase “the spirit catches you.” The concept of spirit in the West is perhaps encompassed by the Christian metaphor of the “Holy Spirit.” What is meant in the Hmong sense of the word, is a “spirit” who steals your soul, not the incarnation of a divine being in the form of a white dove.
The Hmong believe in “the realm of the unseen.” Dragons live in bodies of water, Dab, or spirits, inhabit secret parts of the world, and natural phenomenon has divine meaning. The Hmong system of science is based on what cannot be known, what is not understood. Western science is perhaps in some way opposite. It is based on what is empirically known, what is observable. The Western method is empirical, while the Hmong method is not. For example, Hmong express concern that patients in an American hospital are made to undress in order to be examined by a physician. From the point of view of a Western doctor, this is for empirical reasons. Doctors must be able to inspect the body for signs of disease or other abnormalities. The Hmong doctor does not require patients to undress, but instead can diagnose the problem while keeping them with their clothes on.
It’s not surprising, then, that the Hmong began to view Western style of medicine with suspicion. The Hmong physician, according to Fadiman, takes hours and hours spending time with his subject, before doling out medical advice. As a way of contrast, in a typical American hospital, patients must wait for a very long time before they are allowed to see a doctor. And it could come as a surprise that once the doctor “is in” he or she may only spend ten to twenty minutes with a patient. This is a stark contrast in cultural difference between the Hmong and the American cultures.
Fadiman rightly connects the Hmong fascination with American medical practices as a preoccupation with “nothing less than a preoccupation with life (and death and life after death). Lia Lee’s parents were born in Laos, and she birthed herself fourteen children. While American readers may be impressed by Foua Lee’s expert ability to be her own obstetrician, it does more to show us how deep the Hmong’s attunement to life and death really is. When coupled with the idea that the Hmong want to be left alone, and Fadiman’s observation that a minority’s request to be left alone is the most difficult request any minority can make of the majority culture, it is easier to realize why the chain events happened the way they did. The Superior Court of the State of California immediately acted on Neil Ernst’s report of Lia Lee’s grand mal seizure. Political connections can be made in the text, and to the fact that the CIA covertly involved itself in Laos’s political turmoil. The country fell to Communist forces in 1975 which precipitated the emigration of 150,000 Hmong to resettle in the State of California.
Culture informs both social life and individual psychology, and shapes how people perceive and act in the world. To understand why it is the father who buries his child’s placenta, and not the mother, is to understand how the Hmong view the role of father, mother, wife, and husband. The book challenges us to think about parenthood, and cultural values ascribed to parenting. What makes a good parent? It is a difficult challenge to ascertain whether or not the medical staff at Merced did the right thing by calling Child Protective Services. The language of the documents are laced with words like “failure” and “administering sub-therapeutic medication levels” when describing Lia Lee’s parents’ attempt to heal their child. Were Lia Lee’s parents not good enugh parents? In whose eyes?
One limitation of ethnography is placing yourself in the environment, or as they say, “in the field.” Fadiman references this difficulty several times in the book, first by talking about how the Hmong like to tell stories in many different ways, and recounting the fact that it can take hours to tell a story. She calls it the paradigm of the fish soup, based on a Hmong man’s forty-five minute explanation on how to make fish soup, replete with a tree-like graph he drew on a chalkboard for his listeners. It is striking that the Western style of gathering knowledge resembles an outline, similar to the way a student organizes a research paper. For the Hmong everything in the world is connected, and simultaneously, everything is both central and peripheral. There is no center that holds everything together. A thesis statement at the beginning of the paper would be strange.
How does the ethnographer respect different forms of knowledge, and how does she carefully represent cultural knowledge in an objective way, but also remains intellectually honest? An ethnographer must be an expert listener, and a careful collector of sources. The job description calls for an objective researcher, but it is hard to believe that Fadiman, considering how invested she had become in Lia Lee’s story, would not become emotionally connected to the events she was attempting to record.
At a personal level, people confront cultural differences all the time. It is easy to fall on our own explanation for cultural practices, and to think of as “strange” or “weird” cultural practices that differ from our own. The practices of the txiv neeb, the Hmong healer, must sound strange to someone not conversant with Hmong culture. But it is also necessary to see, for example, how the practices of an American medical doctor must seem strange to the Hmong!
The common thread that all cultures share is the idea of the unknown. The unknown excites our imagination because there is no explanation for it and “we do not know, quite obviously, what the unknown is” (Bille 162). Typically, human beings are afraid of what they don’t know, so they rely on belief systems to help them understand. The txiv neeb who chants on a street in California, calling out to “the realm of the unseen” really isn’t all that strange, when considered from from a desire to understand, to know, and to comprehend that which appears at first glance to be unknowable. This is valuable information for those in the professional medical field, for they may be satisfied with the belief that contemporary medical science can answer the questions of how to cure and prevent illness. But in the medical profession, not all is known. There are still plenty of unknowns.
One of the positive attributes of Fadiman’s ethnographic work is she shows us how the medical professionals interacted with the Lee family. The majority of quotes Fadiman collects in the book do show the medical team at Merced as hopelessly unable to empathize. For example, Lia Lee’s hospital room was always filled with cousins, family members, who in the words of an attending nurse, “Those people would all yak and raise their voices and gesticulate at each other . They were totally fed up with us. They'd ask us what were we doing? Why were we doing it? There wasn't a question asked that hadn't been answered ten times over. Anything we were doing was wrong” (175). Notice how the medical staff’s inability to figure out the cultural practice of the Hmong seem to lead them to believe that the Hmong were dissatisfied.
There is also a conflictual story that emerges, between expectations and the reality of the cultural difference. Fadiman reports that the Hmong say they feel slighted when they do not receive a prescription if they go to the hospital with the flu, but hospital official say when they give medication to Hmong patients, they often do follow the instructions given by medical staff. Telling one Hmong patient to take a tablespoon of medicine, the Hmong patient asks “What’s a tablespoon” (70). The story is a reminder of how much of one’s cultural practices are taken for granted, and people sometimes do not understand (or appreciate) how much has to be relearned when introduced to a different and unfamiliar culture.
The final thought that must be said: this book is a guide for trying to understand cultural difference. It is useful not only for parsing out the complexities of cultural practices, but also for putting the lens on ourselves, and helping us to better our dealings with others. It is the use of one’s sociological imagination to make the everyday strange. To make it “strange” is to make it less part of of the everyday, and therefore more applicable to objective study. Becoming “strangers in a strange land” (Exodus 22:2) it is then possible to try to see things that are familiar as strange, and to see the strange as familiar.
Works Cited
Bille, Mikkel, Frida Hastrup, and Tim F. Sørensen. An Anthropology of Absence:
Materializations of Transcendence and Loss. New York: Springer, 2010. Print.
Collins, Derek. Magic in the Ancient Greek World. Chichester: John Wiley & Sons, 2008.
Internet resource.
Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American
Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux, 1997. Print.
Malless, Stan, and Jeff McQuain. Coined by God: Words and Phrases That First Appear in
the English Translations of the Bible. New York: Norton, 2003. Print.
Pratt, Mary Louise Pratt. “Fieldwork in Common Places.” in Writing Culture: The Poetics and
Politics of Ethnography : a School of American Research Advanced Seminar. Edited by Clifford, James, and George E. Marcus. Berkeley: University of California Press, 1986, 27-50. Print.
