Explanatory Health Model

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

“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.

Even though Foua and Nao Kao never completely understood the reasons for why they had to administer Lia with so many prescription drugs, they eventually participated in proper medication trainings with the social worker in order to comply and appease the doctor’s demands. Over time, Foua and Nao Kao were able to develop a good relationship with Lia’s doctors, with the assistance of the family’s social worker, Jeanine Hilt, in order to regain custody and comply with the medication regimen. This was a difficult concept for them to grasp, as the methods of the doctors were completely foreign to them, and they felt they had no control in what was happening to Lia who they, according to their cultural values, wanted to take complete responsibility

Their view about epilepsy therefore reflects their cultural belief. After Lia was born a ceremony was performed in which strings were tied on Lia’s wrist in order to “bind her soul securely to her body” (Fadiman, 1997, p.11). This is why they may have believed that her soul left after her sister banged the door, and that this must have caused Lia’s sickness.

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.

This entry book” spirit catches you and you fall down” is talking about the cultural conflict between the Hmong's culture and American culture. These differences are brought by the strong beliefs in the Hmong's culture, and the difficulties to accept a new culture. There is a lot of misunderstanding/conflicts between these two cultures in the book. Usually, when the doctors are trying to convince the Lee's family about Lia's treatments, the Lees are stuck in their ways and really hard to accept what the doctors have to say about their beloved daughter. They believe in their own ways, even if it is helpful or not. They refuse to accept the doctors' ideas, and because the treatments that the doctors give are based on the scientific experiences, so the doctors believe that the Hmong's ideas are unreasonable or even stupid .However, when the culture conflicts face the love, these cultural differences become meaningless, which lead me to think that love is the only way that bring these cultures to connect.

The first time Lia was brought into the hospital it was hard for the doctors to understand the Lee families beliefs. Jeanine Hall was the only person that took into consideration their beliefs and values. Hall was Lia’s social worker

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.

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.

4. There were many people affected by the Lia’s seizures and the cultural clashes that ensued. I will focus on the two that seemed most significant. The first people who were affected were her family, namely her parents. Nao Kao and Foua were obviously distressed that their youngest daughter was having these seizures. The Hmong in general are excellent parents, providing their children with an extraordinary amount of love and attention (Fadiman, 1997, p. 22) and I can’t even imagine the amount of grief the Lees dealt with as they watched Lia’s soul slip away during those several tumultuous years of her life. Because the Lees blamed the medical system for the end result of Lia’s vegetative state, they became increasingly angry people, Nao Kao in particular. Fadiman tells us how angry he was several times in the book, angry enough to try to steal Lia away from the hospital (p. 213). While Foua more evenly tempered than her husband, she did show severe signs of depression and even suicide when Lia was first taken away from them and placed in

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.

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.

This report will be investigating the various sociological perspectives on health as well as the models and definitions of health and ill health. These topics will assist in the understanding of how different people and different cultures react to ill health.

Another model of health that evolved over time is the physical-mind model. This model purports that a person’s overall state of health or ability to heal can be affected on how or what they think. For instance, that depression or anxiety can negatively impact a critically ill patient’s ability to heal. It also recognized that feelings or emotions can physically manifest as illness. For example, someone who is extremely anxious can give themselves an ulcer, without doing something to physically harm themselves. Simply being under significant stress can cause a physiological response to stimulate the creation of more stomach acid and wears a hole in the lining of the stomach, creating an ulcer. When using this model of health, doctor and nurses can treat a person, mind and body, when they have an illness.

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.