The Difference in Culture in Anne Fadman´s The Spirit Catches You and You Fall Down

“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.

In 1946 the World Health Organisation (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition integrates the main concepts of health and identifies that health can be viewed differently by individuals and groups (Bowden, 2006). Health and well-being are the result of a combination of physical, social, intellectual and emotional factors (Dunkley, 2000a).

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.

Lia Lee born and raised in America, but brought up as a Hmong, faced health issues specifically epilepsy. Her parents who practice the Hmong culture had a different view on how to handle Lia critical condition. Hmong did not believe in traditional medicine but believed in Txiv neeb, person with a healing spirit. Not only do they believe in a person with healing spirit to help cure their illness but also consider epilepsy as power; “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (Fadiman, 1998, p.21). Right at this moment is where you can tell conflict is going to occur.

Anne Fadiman’s novel, The Spirit Catches You and You Fall Down, addresses key concerns regarding health and medicinal relationships with cultural beliefs. She challenges readers to consider what is known about western medicinal practices and beliefs, based on science, and recognize its effectiveness when paired with cultural understanding. This novel portrays some of the greatest medicinal and health challenges and cultural failures of western societies. There were several cultural competency themes integrated throughout the book, however, it surprised me at how distant western practices and the Hmong’s healing methods were at the beginning. It seemed as if it would be a stretch to form a connection between these two extremities,

Anne Fadiman wrote this book to document the conflict between cultural barriers and how they affect medical issues. In this book, Lia Lee is a Hmong child was has epilepsy and battles cultural medical differences. The main struggle in this story is the conflict between the doctors and parents because they cannot seem to get on the same page. While writing the book, Fadiman stated that there was a “clash of cultures”. (Fadiman, preface) Meaning, there are two different sides to the story and the problem has not be solved.

The definition of health is the state of being free from illness and injury, it can also be used to explain a person’s mental or physical condition.

The Spirit Catches You and You Fall Down or quag dab peg is said to mean “a soul stealing dab; peg means to catch or hit; and quag means to fall over with one’s roots still in the ground, as grain might be beaten down by wind or rain” (Fadiman, 1997). The Lee family belonged to the Hmong tribe, which was the basis of their differing beliefs in comparison with modern medicine. Lia’s parents believed that when she was three months of age, she had been startled when her older sister, Yer, slammed the door of the Lee family’s apartment. This resulted in Lia’s first seizure which her parents believed made Lia particularly fit for divine office. The Hmong believed epileptics became shamans or medicine men and

It is not always easy to decide about the care of a patient, because the patient’s cultural beliefs do not always coincide with the beliefs of the nurse. Ephesians 4:2 in “Be completely humble and gentle; be patient, bearing with one another in love” (English Standard Version). God has loved us unconditionally from the beginning of time, and has always been patient with us. It is time that humans show the love that God has for us onto others and respect one another no matter the differences. This paper will discuss the importance of respecting another person’s culture, what stigma is and whether if Lia’s family viewed her that way, brief history of the Hmong, the preventions that could have taken place, and how to incorporate

Naidoo and Wills(2001, p.47) “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ - WHO (1946).” This definition falls into a holistic way of defining health, which believes that there are more areas to look at when thinking of health than just simply the absence of a disease. It considers the cause of why someone is ill and not just simply about ’fixing it’.

But over the past few decades, the definititon and concept of health has evolved to encompass more elements than just the physical well-being of a person. This is partly attributed to various researches and studies that have taken place around the world in the last 60 years. Already in 1948, the World Health Organization declared that health is “a state of complete physical, mental and social well being and not

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.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948.)

According to Floyd, Mimms and Yelding (2008) Webster’s Dictionary defines health as “the condition of being sound in body, mind and spirit… freedom from physical disease or pain.” This definition has very much taken the holistic view. Wellbeing is a term in which reflects on the positive emphasis on health and can be broken down into six aspects know as environmental, physical, social, emotional, mental and spiritual. To achieve a high balance of wellbeing it is vital that a person is able to balance and take care of each aspect effectively. Underdown (2007) implies that in 1948 the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not just the absence of disease or infirmity.’ This definition took a holistic view as it mentions mental and social wellbeing and it was supported as it focused on a person being healthy rather than not being ill. However, this definition has been widely criticized. Seedhouse (1986) believed that for someone to be in perfect state of health is unachievable and unrealistic.

”Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (WHO, 1948) Wellness