The Spirit Catches You and You Fall Down
Encyclopedia
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures is a 1997 book by Anne Fadiman
that chronicles the struggles of a Hmong
refugee family from Sainyabuli Province, Laos
, the Lees, and their interactions with the health care system in Merced, California
.
On the most basic level, the book tells the story of the family's second youngest and favored daughter, Lia Lee (Romanized Popular Alphabet
: Liab Lis), who is diagnosed with severe epilepsy
, and the culture conflict that obstructs her treatment.
Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust and misunderstandings, and the inability of the doctors to have more empathy toward the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia's condition worsens. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme of the book.
The book is written in a unique style, with every other chapter returning to Lia's story and the chapters in-between discussing broader themes of Hmong culture, customs, and history
; American involvement in and responsibility for the war in Laos; and the many problems of immigration, especially assimilation and discrimination. While particularly sympathetic to the Hmong, Fadiman presents the situation from the perspectives of both the doctors and the family. An example of medical anthropology
, the book has been cited by medical journals and lecturers as an argument for greater cultural competence
, and often assigned to medical, pharmaceutic, and anthropological students in the US. It won the National Book Critics Circle
Award for Nonfiction.
animism
asserts that malevolent spirits are constantly seeking human souls, especially those of vulnerable or unloved children. In Hmong culture, epilepsy is referred to as qaug dab peg (translated in English, "the spirit catches you and you fall down"), in which epileptic attacks are perceived as evidence of the epileptic's ability to enter and journey momentarily into the spirit realm. In Hmong society, this ability must be used to help others. Qaug dab peg is often considered an honorable condition and many Hmong shamans are epileptics, believed to have been chosen as the host to a healing spirit, which allows them to communicate and negotiate with the spirit realm in order to act as public healers to the physically and emotionally sick. In addition to these beliefs, Hmong also have many customs and folkways that are contradicted by those of the American mainstream and medical communities; for example, some Hmong traditionally perform ritual animal sacrifice and because of very specific burial traditions and the fear of each human's many souls possibly escaping, the traditional Hmong beliefs do not allow for anyone going through invasive medical surgery.
In the U.S., the medical community rarely has ways to communicate with people of cultures so radically different from mainstream American culture; even a good translator will find it difficult interpreting concepts between the two different cultures' world-concepts. American doctors, unlike Hmong shamans, often physically touch and cut into the bodies of their patients and use a variety of powerful drugs and medicines.
New England Journal of Medicine article 2 http://content.nejm.org/cgi/content/extract/353/13/1317
Anne Fadiman
Anne Fadiman is an American author, editor and teacher.She is the daughter of the renowned literary, radio and television personality Clifton Fadiman and World War II correspondent and author Annalee Jacoby Fadiman...
that chronicles the struggles of a Hmong
Hmong people
The Hmong , are an Asian ethnic group from the mountainous regions of China, Vietnam, Laos, and Thailand. Hmong are also one of the sub-groups of the Miao ethnicity in southern China...
refugee family from Sainyabuli Province, Laos
Laos
Laos Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ Sathalanalat Paxathipatai Paxaxon Lao, officially the Lao People's Democratic Republic, is a landlocked country in Southeast Asia, bordered by Burma and China to the northwest, Vietnam to the east, Cambodia to the south and Thailand to the west...
, the Lees, and their interactions with the health care system in Merced, California
Merced, California
Merced is a city in, and the county seat of, Merced County, California in the San Joaquin Valley of Northern California. As of the 2010 census, the city had a population of 78,958. Incorporated in 1889, Merced is a charter city that operates under a council-manager government...
.
On the most basic level, the book tells the story of the family's second youngest and favored daughter, Lia Lee (Romanized Popular Alphabet
Romanized Popular Alphabet
The Romanized Popular Alphabet or Hmong RPA , is a system of romanization for the various dialects of the Hmong language. Created in Laos between 1951 and 1953 by a group of missionaries and Hmong advisers, it has gone on to become the most widespread system for writing the Hmong language in the...
: Liab Lis), who is diagnosed with severe epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, and the culture conflict that obstructs her treatment.
Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust and misunderstandings, and the inability of the doctors to have more empathy toward the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia's condition worsens. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme of the book.
The book is written in a unique style, with every other chapter returning to Lia's story and the chapters in-between discussing broader themes of Hmong culture, customs, and history
Hmong customs and culture
The Hmong people are an ethnic group in several countries, believed by some researchers to be from the Yellow Basin area in China. The Hmong are known in China as the Miao, a designation that embraces several different ethnic groups...
; American involvement in and responsibility for the war in Laos; and the many problems of immigration, especially assimilation and discrimination. While particularly sympathetic to the Hmong, Fadiman presents the situation from the perspectives of both the doctors and the family. An example of medical anthropology
Medical anthropology
Medical anthropology is an interdisciplinary field which studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives...
, the book has been cited by medical journals and lecturers as an argument for greater cultural competence
Cultural competence
Cultural competence refers to an ability to interact effectively with people of different cultures, particularly in the context of human resources, non-profit organizations, and government agencies whose employees work with persons from different cultural/ethnic backgrounds.Cultural competence...
, and often assigned to medical, pharmaceutic, and anthropological students in the US. It won the National Book Critics Circle
National Book Critics Circle
The National Book Critics Circle is an American tax-exempt organization for active book reviewers. Its flagship is the National Book Critics Circle Award....
Award for Nonfiction.
Theme of cultural dissonance
The Hmong religious belief in shamanisticShamanism
Shamanism is an anthropological term referencing a range of beliefs and practices regarding communication with the spiritual world. To quote Eliade: "A first definition of this complex phenomenon, and perhaps the least hazardous, will be: shamanism = technique of ecstasy." Shamanism encompasses the...
animism
Animism
Animism refers to the belief that non-human entities are spiritual beings, or at least embody some kind of life-principle....
asserts that malevolent spirits are constantly seeking human souls, especially those of vulnerable or unloved children. In Hmong culture, epilepsy is referred to as qaug dab peg (translated in English, "the spirit catches you and you fall down"), in which epileptic attacks are perceived as evidence of the epileptic's ability to enter and journey momentarily into the spirit realm. In Hmong society, this ability must be used to help others. Qaug dab peg is often considered an honorable condition and many Hmong shamans are epileptics, believed to have been chosen as the host to a healing spirit, which allows them to communicate and negotiate with the spirit realm in order to act as public healers to the physically and emotionally sick. In addition to these beliefs, Hmong also have many customs and folkways that are contradicted by those of the American mainstream and medical communities; for example, some Hmong traditionally perform ritual animal sacrifice and because of very specific burial traditions and the fear of each human's many souls possibly escaping, the traditional Hmong beliefs do not allow for anyone going through invasive medical surgery.
In the U.S., the medical community rarely has ways to communicate with people of cultures so radically different from mainstream American culture; even a good translator will find it difficult interpreting concepts between the two different cultures' world-concepts. American doctors, unlike Hmong shamans, often physically touch and cut into the bodies of their patients and use a variety of powerful drugs and medicines.
See also
- History of the Hmong in Merced, CaliforniaHistory of the Hmong in Merced, CaliforniaThe Hmong are a major ethnic group residing in Merced, California. As of 1997 Merced had a high concentration of Hmong residents relative to its population...
External sources
New England Journal of Medicine article 1 http://content.nejm.org/cgi/content/extract/353/13/1316New England Journal of Medicine article 2 http://content.nejm.org/cgi/content/extract/353/13/1317
External links
- The Spirit Catches You and You Fall Down - McMillan
- The Spirit Catches You and You Fall Down (Archive)
- "Ann Fadiman: “Go to the Edge of Your Culture”." Inside Chico State. Volume 32, Number 4. October 25, 2001
- Yang, Yeng. "Practicing Modern Medicine: "A little medicine, a little neeb"." Hmong Studies JournalHmong Studies JournalThe Hmong Studies Journal is an irregularly published, peer-reviewed academic journal covering studies on the Hmong people. The journal was established in 1996 and the editor in chief and publisher is Mark Pfeifer. The journal is indexed by Academic Search Complete and ProQuest....
. v2n2. northern hemisphere Spring 1998. - Ernst, Neil and Peggy Philp. "Bacterial Tracheitis Caused By Branhamella Catarrhalis." Pediatric Infectious Disease Journal. June 1987. Volume 6, Issue 6. Page 574.
- Lilly, Amy. "Influential Author Discusses How Culture Clash Became Tragedy." Seven DaysSeven Days (newspaper)Seven Days is an alternative weekly newspaper that is distributed every Wednesday in Vermont. Seven Days is published by Da Capo Publishing, Inc., and owned by Pamela Polston and Paula Routly. It is distributed free of charge throughout the following areas: Burlington, Middlebury, Montpelier,...
. February 17, 2010. - Lammert, Kathy. "When Epilepsy Goes By Another Name." Epilepsy.com. September 15, 2003.
- Chrismer, Ellen. "Fadiman visit stirs emotions, understanding." University of California-Davis. December 6, 2002.