Analysis Of The Spirit Catches You And You Fall Down

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

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.

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.

The Lees believe that for an illness to be cured the soul has to be called back through the ritual sacrifice of animals such as chicken and pig. That is, they believe in the “Shamanistic ritual performed by a trix neeb in which an animal is sacrificed and its soul battered for the vagrant soul of a sick Person” (Fadiman, 1997, p.100). According to Lia's father Nao Kao “Sometimes the soul goes away but the doctors don’t believe it…The doctors can fix some sickness that involve the body and blood but for us Hmong some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb” (Fadiman, 1997,p.100). The medical care that the doctors at Merced were providing was without animal sacrifices therefore the Lee’s believe that it could not make their daughter well.

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 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.

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.

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.

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

What do you think of traditional Hmong birth practices (pp. 3-5)? Compare them to the techniques used when Lia was born (p. 7). How do Hmong and American birth practices differ?

10. The Spirit Catches You and You Fall Down revolves around a small child who for much of the book is too young to speak for herself, and at the end is unable to. Do you nonetheless feel you know Lia Lee? Do you believe that even though she cannot walk or talk, she is a person of value? Why?

All communication is cultural. It draws on ways we have learned to speak and give nonverbal messages. We do not always communicate the same way from day to day, since factors like individual personality, mood, and the context of the situation interact with the variety of cultural influences we have internalized that influence our choices. Communication is interactive, so an important influence on its effectiveness is our relationship with others. Do they hear and understand what we are trying to say? Are they listening well? Are we listening well in response? Do their responses show that they understand the words and the meanings behind the words we have chosen? Is the mood positive and receptive? Is there trust between them and us? Are there differences that relate to ineffective communication, divergent goals or interests, or fundamentally different ways of seeing the world? The answers to these questions will give us some clues about the effectiveness of our communication and the ease with which we may be able to move through conflict. The challenge is that even with all the good will in the world, miscommunication is likely to happen, especially when there are significant cultural differences between communicators. Miscommunication may lead to conflict, or aggravate conflict that already exists, or in the sad of case of girl developing epilepsy and both her parent’s Hmong culturally clashing with her Western medicine

Facing transitions and dealing with dramatic change has a influencing aspect on family and personal relationships, through the text we see the dynamics of relationships and roles of family shift to meet the needs of each individual as they face the challenge of moving in to the world before them. the manner in which the various members of the Brennan family relate to each other, as well as the horrible

In Hmong culture seizures are not recognized much as a physical illness as it is spiritual in nature and quab dab peg which translates to, the spirit catches you and you fall down, describes the group of symptoms experienced by Lia in the Hmong culture. The Lee’s were both happy and sad about Lia’s seizures. In Hmong culture seizures are considered to have special powers and usually become Shamans, but at the same time the Lees were worried about their child’s health.

Lia Lee was a Hmong infant born with epilepsy. Lia’s parents were immigrants to a Western nation. However, the parents held tightly onto traditional beliefs from their native country. The incongruent belief structure of the East and West created difficulty when the two systems collided in an effort to care for Lia Lee. Specifically, when the drug therapy prescribed for Lia Lee was not followed by her parents. Subsequently the child’s medical team contacted child services, which lead to Lia’s removal from her family. The result of the cultural misunderstanding was fragmented family. In addition to fueling the distrust of the western healthcare system by an already marginalized community.