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“The Spirit Catches You and You Fall Down” Book Review

The book The Spirit Catches You and You Fall down by Anne Fadiman is one of the highlights of the Hmong culture and the challenges socializing a family from Laos faces in American society. Misunderstandings and disagreements manifested in day-to-day interactions reveal distinctive values ​​and norms in the two cultures. The Lee family where little daughter Lia is growing up does not accept many aspects of life in the United States, which, in turn, affects their well-being. For instance, the parents’ reluctance to give Lia her medicine as prescribed is the result of a significant gap between the two cultures and the Lees’ poor recognition of the scientific nature of the medical treatment. Their motivation is understandable because, as Fadiman (1998) notes, the shamanistic practices promoted in the Hmong culture have nothing to do with the Western approach to pharmacology and are not credible to refugees. However, Lia’s parents’ decision to shield their child from medical intervention is not sympathetic.

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Since the girl has a severe form of epilepsy, her health is at risk, and the help of qualified professionals is important. However, the reluctance of Nao Kao and Foua Yang, her parents, to delve into the specifics of treatment and understand its scientific basis indicates the limited thinking of these adults. Their adherence to traditions at the expense of the child’s health is an aggravating factor. Lia draws sympathy for her parent’s failure to provide comprehensive care due to behavioral and cultural constraints that explain Lees’ reluctance to follow medical prescriptions.

Despite a firm belief that American physicians cannot understand the motives and deeper aspects of the Hmong culture, Lia’s parents have confidence in Jeanine Hilt, a social worker who helps their family. Unlike other Americans, she does not seek to impose Western treatment on the Lees at any cost. Fadiman (1998) writes that “Jeanine was the only American I talked to who didn’t describe the Lees as closemouthed and dim” (p. 111). This attention to the traditional family culture is the decisive factor that allows Janine to succeed. The Lees see that the woman does not seek to promote Western values by all means. Conversely, she wants to learn more about the traditions of the Hmong culture to be aware of what methods of working with the family are better to apply. This approach helps her earn the trust of the Lees and become the only social service provider Foua Yang and Nao Kao can count on and respect.

Moreover, Jeanine Hilt not only respects the Hmong culture but also strives to understand it to realize the characteristics of social interaction and the values promoted by the family. Her willingness to go against the ingrained norms of the US healthcare policy is the factor that sets her apart from her colleagues. Therefore, Lia’s parents have sympathy and support for this woman due to her respect and willingness to accept the lifestyle that the refugee family promotes.

While reading the book, one can note that Fadiman (1998) does not include overt villains as characters in the story. In other words, there are no antagonists as those whose ideas and values ​​are perceived negatively and condemned by protagonists. From the standpoint of fiction, this method of narrative may be regarded as a flaw due to the absence of conflict and tension among the characters. Nevertheless, the genre of the book as a popular science story does not imply creating vivid artistic images. Conversely, such an approach allows one to present the values ​​and norms of two different parties impartially and without an obvious preponderance in a particular direction. One of the characters in Fadiman’s (1998) story notes that the truth can be different, and “consensual reality is better than facts” (p. 94). In other words, everyone has the right to interpret life and its features in accordance with individual views, and this fact explains the absence of obvious antagonists in The Spirit Catches You and You Fall down.

As a result, the two sides represented by American society and representatives of the Hmong culture have individual motives, and the author acts as an outside observer by giving the reader an opportunity to draw conclusions. This approach demonstrates open-mindedness and encourages reflection, which makes the book more profound than it might seem at first glance. Therefore, the absence of obvious villains is not a flaw, and all events and relationships among the characters are close to reality.

The misunderstanding between the two parties, namely the Lee family and American medical practitioners, forms the background of the book in question. Fadiman (1998) quotes Dr. Murphy, one of the characters, who argues that “the biggest problem was the cultural barrier” but not the language one (p. 91). The meaning of this statement lies deeper than it might seem at first glance. In addition to the differences in worldview and everyday nuances, the Hmong culture differs from the American one of the lack of understanding of many concepts and approaches that seem natural to Western people.

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Dr. Murphy makes arguments regarding medicine and, in particular, human physiology and notes that the anatomical features of the body are incomprehensible to the Hmong since these people have never encountered them directly. The scientific discoveries of the Western world are incomprehensible to refugees from Laos. Interaction difficulties caused by the language barrier can be overcome. However, medical interventions as procedures based on the treatment of internal organs and systems are not understood by the Hmong due to their distinctive views on the culture of healthcare. Thus, the cultural barrier carries more constraints and limitations than the ordinary challenges of communication, and this forms the core of Dr. Murphy’s argument.

This distrust of professional healthcare is characteristic not only of the Lee family but of the Hmong community as a whole. At the end of the story, Fadiman (1998) quotes the aforementioned Dr. Murphy, who regrets what has happened but does not know how to change the situation. He remarks “that when you fail one Hmong patient, you fail the whole community” (Fadiman, 1998, p. 253). The essence of this conclusion is that, based on Lia’s case, the doctor notes that there is a close connection between representatives of the Hmong culture and their high confidence in one another. Traditional values lost in immigration but preserved within their community bring refugees together and shape their common perception of the world. Any form of disagreement with the existing order is a feature of not one family but of their entire cultural environment. Therefore, based on Lia’s case, Dr. Murphy concludes that interaction is difficult.

In addition to this conclusion, one can interpret Dr. Murphy’s words about consensus in the Hmong community from the perspective of similar educational properties. Prejudices about the uselessness of medical work and approaches to treatment are the feature of all refugees, who, having neither experience nor knowledge about the specifics of such interventions, tend to question doctors’ professionalism and qualifications. As a result, the consensus bolstered by a bad experience with Lia is an example of how the mass consciousness based on similar educational principles cultivates the disadvantages of healthcare promoted in the Hmong community.

To prevent the tragedy and preserve Lia’s health, both doctors and parents could make concessions to each other. Neil Ernst and Peggy Philp, who were sincere in their desire to help the girl, faced the reluctance of her loved ones to accept Western medical practices and agree to the treatment offered. Nao Kao and Foua Yang, in turn, refused to entrust their daughter to specialists and did not believe in the arguments about the need for serious medical interventions. As a result, both sides showed stubbornness, which ultimately cost Lia’s health. The task of the medical staff is to provide patients with any possible assistance. Therefore, if the doctors had been less focused on proving the power of medicine and agreed to some of the conditions of the girl’s parents, this could have reduced the likelihood of tragedy. Nao Kao and Foua Yang should have been less categorical in their views. If they had agreed to combine traditional therapies with modern healthcare practices to test all possible treatments, this would have been beneficial to the girl’s health. Thus, a mutual concession could have prevented Lia’s severe health problems.


Fadiman, A. (1998). The Spirit catches you and you fall down. Farrar, Straus and Giroux.

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