Lit Crit Lite – December 2010
by Kris Pikaart
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman has a long title that might need a little interpreting before you are inspired enough to go to the library, check it out, and give it a read – which, by the way, is definitely the point of this little article.
This work of non-fiction takes place, or at least begins, in the city of Merced. The central valley of California is home to many Southeast Asian immigrants, including one of the largest populations of Hmong people in the US. The Hmong people have a complicated and interesting history. Unlike Laotians and Cambodians, with whom they share many characteristics, the Hmong people have never in their many-centuries-old history had a homeland of their own – hence the explanation of their relative anonymity. Originally a tribe from China, this highly independent, but small and poor group of people managed to spend centuries avoiding ever being ruled by an outside group or government. This means that as a people they have relocated many times throughout the centuries, eventually landing and living in the high mountains on the borders of Laos and Cambodia and Vietnam.
Tens of thousands of Hmong wound up in refugee camps in Thailand after the Laotian Civil War (or the Secret War). They had been recruited (by the CIA) to fight in this civil war and when the Communist forces won, the Hmong were singled out for retribution and fled to safety in Thailand. From there, the UN began refugee relocation programs, moving many Hmong in the central valley of California (Fresno, Merced, Stockton).
Anne Fadiman came to Merced because she heard that there were all sorts of troublesome conflicts happening between the medical establishments in the area and the Hmong immigrants. Upon arriving, the doctors and nurses in the area begin to tell her the story of one particular little girl and her family who had so flummoxed the hospitals, doctors, nurses, and social workers, that her story was one of the first on everyone’s lips.
Enter little Lia Lee. Lia is the fourteenth child of Foua and Nao Kao who arrived in the US just a year or so before her birth in 1982. When she was only a few months old, Lia’s parents noticed that she began to regularly convulse uncontrollably. Eventually (after several un-translated visits to the ER where Lia was sent home with cough medicine for a cough), Lia was diagnosed with Epilepsy.
This story tells of a decade long battle between Lia’s family and the medical practitioners who were trying to care for her. The battle went like this: From the age 3 months to 4-and-a-half years, Lia was admitted to the hospital 17 times and had more than 100 visits to the emergency room because of her persistent and very violent grand mal seizures. Her two primary pediatricians were intimately involved in Lia’s care – tromping out at all hours of the night to care for her personally in the ER rather than involve any of the residents. Over the years, they prescribed various medications for her epilepsy, certain that it should be controllable. But frequently when they did blood work, they would see that her mother wasn’t giving the meds to her. This aggravated the usually unflappable doctors to no end. For years, they sent social workers and public health workers to the house to train the family about the meds, only to find that again and again, Foua would give the meds only when she wanted to, not as prescribed. When she was four and a half, the doctors determined that Lia should be removed from her home and placed in foster care for a time.
Fadiman spent years with Lia’s family and with the Hmong community at large. She learned some facts that no one, in all of their years of intense care for this girl, ever learned. She learned that in the Hmong culture – a highly spiritual and animistic culture – all sickness is caused by a bad spirit (or a dab) getting into the body. One can get a dab in a thousand different ways. In this case, the family believed that Lia’s dab was caused when her big sister Yer slammed the door loudly when she was a newborn. The family diagnosed Lia’s problem not as a neurological problem, but as a spiritual problem, which necessitated many ritual interventions from the Txiv Neev, or shaman. Most of these involved a live animal sacrifice (comically enacted in the family’s little tiny inner-city apartment).
But interestingly, while Lia’s “Spirit Catches You and You Fall Down” (or qaug dab peg) sickness is worrisome to her family, it is also a very important sign. Within the Hmong, people who have these symptoms are known to be gifted with spiritual powers. This means that her family was deeply ambivalent about their daughter’s disease. On the one hand, it was terrible to watch her seizures, but on the other, it was a sign of a special power and authority resting on their favorite child, Lia.
The book chronicles years of ever-increasing distrust growing between the two groups of people – with this sick little girl right in the middle of it all. Because I know that you are going to go read this book for yourself, I don’t want to say any more about how the collision ends, or if it ever does.
I have now read this book three times, so I’m clearly very excited about it. Let me just summarize a few reasons why I think that it is well worth your time.
First, Fadiman is a very tidy writer. You learn a little about neuroscience and a lot about a very intriguing culture written not with dry medicalese or anthropoligese, but with a warm, engaging tone. Second, the story is so delicately balanced that you will see the deep tragedy that exists in all conflicts. Fadiman portrays both the doctors and the Lee family as groups who are truly acting out of the best of intentions, but who simply cannot bridge the gap that divides them. Last, for all of us who live and work at the intersections of cultures – be it in health care, schools, or law enforcement – there is a great deal to learn from this tale. Fadiman gives a powerful reminder that language, belief, and culture are not merely the dress that we wear, but are deep determinates of how we experience and interact with the world. She points out that it is not just the Hmong who hold stubbornly to their culturally prescribed point of view. So too, she suggests, is science and Western medicine simply another culture with its own set of values, its own language, its own beliefs. There are a few real heroes in this tale. They are the unexpected people who through years of faithfulness and respectful listening were able to forge strong bonds of friendship and trust across this great divide of culture.
