Review Of The Spirit Catches You And You Fall Down Book Reviews Examples

Preface; Note on Hmong Orthography, Pronunciation, and Quotations (291-92); Notes on Sources (293-294); Birth; Fish Soup; The Spirit Catches You and You Fall Down
For this first reading, I looked at the surrounding materials relating to the book The Spirit Catches You and You Fall Down – notably, the Preface and the author’s notes on Hmong Orthography, Pronunciation, and Quotations, as well as on Sources. What struck me most clearly was the personal impact these experiences clearly had on Fadiman, and her emphasis in the Preface on establishing the need for cultures to merge and for us to explore the conflicts that happen when this occurs: “I have always felt that the action most worth watching is not at the center of things but where edges meet” (x). In particular, I was intrigued by the continuation of this subjectivity and personal nuance to her Notes sections; in her Orthography section, she notes that the Hmong culture is decidedly ill-studied, with very little in the way of coherent and structured translation or exploration of Hmong and their language. Her exploration of her myriad Sources is shown to be thematically tied to the unusual nature of Hmong culture: “When a Hmong makes Fish Soup, or tells a story, the ingredients tend to come from many different places. My own Fish Soup is similarly eclectic” (293).
This beginning section of Fadiman’s book effectively lays down the groundwork for the case to come; in “Birth,” the birth of little Lia Lee is foreshadowed and supported heavily by a detailed account of her mother, Foua, who is shown to be a dedicated mother living in a loving community and family: “Foua conceived, carried, and bore all her children with ease, but had there been any problems, she would have had recourse to a variety of remedies that were commonly used by the Hmong” (4). Fadiman’s accounts of the Chinese persecution of Hmong are appropriately tragic, making their stubbornness and naivete from a Western perspective understandable. When Lia becomes sick, it is hard to see the Lees as incompetent, as they simply did what they could; however, the Western doctor’s limited preliminary medical report is full of gaps because of the language barrier.

Do Doctors Eat Brains?; Take as Directed

This section of the book is where it really starts to get interesting, as we delve more deeply into the motivations and frustrations of the Western doctors as they try to heal Lia despite the ignorance and alternative beliefs of the Hmong. The Hmong’s fear of medicine was not entirely unearned: “The limited contact the Hmong had already had with Western medicine in the camp hospitals and clinics had done little to instill confidence, especially when compared to the experiences with shamanistic healing to which they were accustomed” (32-33). The questions they had about whether or not doctors took organs, stole blood, and so on relate clearly to a mistrust of foreign medicine, and a steady diet of superstition that makes it hard for doctors Neil and Peggy to do their job.
This fear, in particular, translates quite easily to their care for Lia, as the parents questioned many things the doctors were doing with her: “Nao Kao did not understand why the nurses had tied up his daughter” (43). This causes tremendous tension with the doctors, as even Peggy says, “’I remember wanting to shake the parents so that they would understand’” (56). Some of the most baffling cultural differences happen here, such as when they find out Foua is pregnant once again with her fifteenth child. It is interesting to think about what I would do in that situation, whether I would lose patience sooner than they did: “It was hard to work so hard and not receive a single word of thanks – in fact, to have their efforts invariably greeted with resentment” (57).

High-Velocity Transcortical Lead Therapy; Government Property

In these next chapters, the frustrations of the Hmong dealing with the American medical industry are heightened even more, showing just how severe the culture clash really was. Fadiman’s most successful aspects in these chapters relate to her interviews with those Hmong who would most readily understand English and Western medicine – the Hmong who were most educated and Americanized. Even they, however, distrusted doctors, as they did not see eye to eye with how they should be treated. This hostility rubbed off on the doctors, who joked about treating them with “high-velocity transcortical lead therapy,” which is code for shooting them in the head (63).
However, we also get some uncertainty from Neil, who questions whether or not he himself risked Lia’s health by being so uncompromising in his care. By not respecting the Hmong’s ignorance and fear of doctors, he may have made it harder for them to actually care for her. This part in particular struck me as interesting – should doctors tailor their care to make sure those of other cultures understand it, even if it may not be as effective?

Foua and Nao Kao; A Little Medicine and a Little Neeb

In this section, the author herself enters the story, inserting herself into the narrative, which I thought was an interesting touch. Her introduction also allows the status of the cultural tensions between doctor and patient to be revealed; the doctors told Fadiman it was not worth the time since they assumed the Lees would treat her like they treated them – with fear and ignorance. However, the help of Sukey Waller, the “fixer of hearts,” proved helpful in creating essential outreach for Fadiman toward the Hmong leaders. This way, we get a less judgmental view of the Lee household, as she is much more willing to cater to Hmong culture and beliefs to engender trust.
Of particular interest was this section’s immersion in Hmong culture. Taking a break from the doctors, we get to see the noble simplicity of the Hmong, as they kill animals efficiently as a sacrifice to honor Lia’s return to her home from foster care. The homecoming is suitably bittersweet, as no solutions had been found to the problem of Lia’s sickness, leaving the problem still unsolved. This section makes it apparent that the doctors and the Lees must come to some sort of agreement regarding Lia’s care in order to help her.

War; The Big One

In this particular section, Fadiman takes a break from Lia’s particular story for a bit and focuses on the Hmong people as a whole, offering some needed context for the way their culture has arisen. A mountain-based people, they know how to live in relative isolation, with distinguished subgroups based on elevation, different crops being planted, and so on. The effect of the Vietnam War was particularly hard on them, as they relied on US-sponsored food drops which left them resentful and suspicious of the West since they could no longer take care of themselves.
However, with this context in mind, Fadiman brings us back to Lia, who experiences her biggest seizure to date. This seemed to scare both parties really badly, as it led Neil and crew to perform risky procedures (like spinal taps) without the Lees’ permission, leading them to request for their daughter back. The whole scene feels like a culmination of both Lia’s case and the cultural tensions that have occurred thus far – because the seizure was so dramatic, it is completely understandable that these groups would feel so strongly about taking ownership of her to help her.
Flight; Code X Here, Fadiman provides yet another contrast between the history of the Hmong people and the Lee’s experience within it, as well as how it informs their interactions with the Western doctors. During the Laos conflict, the Lees chose to take a trip to Thailand, Fadiman using that as a means to contextualize the overall exodus of Hmong to other countries, such as America. This section of the book, while a bit repetitive of other chapters, provides a bit more information as to why the Hmong are distrustful of the West; having had such a tumultuous history, only to come to America seeking refuge and put in camps where they are looked down upon, it is easy to see Americans as snide imperialists. That assessment is not entirely wrong; Americans and other Westerners are shown to be incredibly dismissive of the Hmong. However, Fadiman gives the Hmong credit for their resourcefulness and their reliance on spirituality to save them: “For as long as there have been Hmong, there have been ways to get out of tight spots” (170).
In the case of Lia, this also shows how unused the Lees were to medical problems: “Violence, starvation, destitution, exile, and death were, however horrific, within the sphere of known, or at least conceivable, tragedies” (171). Even when the doctors felt the end was near and let the Lees take Lia home, they brought her right back to wellness using herbal remedies. This makes me wonder about the applicability of holistic medicine, or whether or not it was a coincidence.
The Melting Pot This chapter I find incredibly important, as it mixes Fadiman’s exploration of the history of Hmong culture and the struggles they went through with the personal story of the Lees, showing how they first arrived in America. Their tales of assimilation and fitting in are intriguing, between the mandatory acclimation classes (“The first sentence they memorized was ‘I am a good American’”) and the inevitable clustering of Hmong into their own groups, making it hard to fully integrate into American culture (182).
This particular trend is a fascinating one from an anthropological perspective, as this is what made it uniquely difficult for the Lees to fit in in America and understand American culture. The Hmong essentially wanted to keep their traditions and isolationism within a small patch of America, interacting little with the West even though they were forced to be there. This aspect of this chapter is most interesting to me, and possibly was a contributing factor to the cultural tensions found in the book.

Gold and Dross; Why Did They Pick Merced?

Perhaps the most interesting thing about this reading is the gradual coming around of Fadiman and some of the physicians to the Hmong way of thinking, insofar as the different ways the two cultures were trying to treat her. “I could not help feeling that something was missing beyond the neurotransmissive capabilities of her cerebral cortex, and that her parents’ name for it – her plig, or soul – was as good a term as any for it” (211). When the Lees took care of Lia, even after she basically became brain dead, Fadiman notes that she looked better and was better taken care of as a vegetable than she was when she was active.
All of this blends together into the Hmong interaction with their American brethren in their respective cultures, including Merced. Despite the cultural tensions that inevitably occur, the Hmong are considered to “have the best leadership, they’re the most able to cooperate among themselves, they’re the most committed to preserving their ethnic identity, they’re the most conscious of their own place in the world” (229). In this way, their isolationism and stubbornness comes from a place of integrity which should be lauded.
The Eight Questions; The Life or the Soul Fadiman’s true success in this section is showing how the Lees grow up around Lia, as the parents grow old and the children grow up. Meanwhile, Neil and Peggy return to the story, as Fadiman updates them on Lia’s progress and the mistakes they may have possibly made in their treatment of the Lees. Thankfully, “their desire to ferret out the truth outweighed their desireto defend their reputation for infallibility,” showing their newfound desire to learn and understand them (255). This chapter ends with what is likely the primary thesis of the book, relating to the arrogance of Western medicine and their inability to reach out to the Lees to get their trust: “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” (261).
What is the secret, then? I feel that the large number of Hmong failure stories in the second chapter of the reading could have been fixed with what Fadiman calls “sensitive bicultural interpreting,” a greater sensitivity to the needs of patients with a different culture (266). While the doctors value life, the Hmong value the soul, and this is something that must be acknowledged if any progress is to be made in a case like this.

The Sacrifice; Acknowledgments (327-329)

Lia’s healing ceremony heads up the final chapter, which is a fascinating exploration of the intermix of cultures in America, particularly with the Hmong. Pigs are sacrificed behind the hospital, a shaman known as a Txiv neeb chants for Lia’s soul behind the hospital while the Lees watch, and so on. Fadiman writes this section with a decided level of drama and tension, ending the book on an open-ended note as if to imply that, if anything will work, this spiritual sacrifice will.
The book ends on an interesting perspective that advocates for cultural sensitivity, but admittedly leans more toward the Hmong’s righteousness to do as they please with their child, given that they end on the Lees and a decidedly spiritual Hmong tradition. The acknowledgements themselves are fascinating as well, showing more of Fadiman’s emotional involvement in the proceedings; she says of Lia, “of the many sadnesses in the world that I wish could be righted, your life is the one I think of most often in the small hours of the night” (329).

References

Fadiman, A. (1997). The spirit catches you and you fall down. Farrar, Strauss and Giroux.