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The Spirit Catches You and You Fall Down by Anne Fadiman


Authored by Anne Fadiman, the book, The Spirit catches you and you fall down, unfolds the drama of clashing epistemologies. The book narrates a story of a “family whose second youngest daughter (Lia Lee) struggles with illness having been diagnosed with idiopathic epilepsy” (Guerrero, Laughrea, McVicker, & Bradley, 2002, par. 2). In Hmong, the condition is referred as the spirit catches you and you fall down (Renée, 2006).

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To the Hmong, Lia Lee’s condition is not an illness, but a divine gift. However, to the American doctors, idiopathic epilepsy is a serious ailment, which they do not know its cause. In this sense, Fadiman (1997) makes it clear that Lia Lee’s condition is not even diagnosable in the medical context. Laboratory tests have not established the cause of the illness. Therefore, Lee proves that cultural conflict may obstruct treatment process for different ailments. This realization suggests that even though the Hmong culture seems primitive, doctors are equally confused when they inform that Lia Lee was diagnosed with epilepsy of unknown cause (idiopathic epilepsy) (Malina, 2005)

Fadiman (1997) presents how cultural relativism affects medical practice. Renée (2006) argues that Anne Fadiman wanted to prove that the effectiveness of medicinal approaches to treatment of different ailments is subject to the action of people’s perception about their effectiveness and that cure only takes place when there is a common understanding between the patient and the doctor on causations of ailments and appropriate remedies. Guerrero et al. (2002) support this assertion by claiming, “Fadiman encapsulates the Hmong way of life in the United States as it is ensnared by western medical epistemology” (para.1). The medical epistemology is influenced by the American culture and treatment approaches are inspired by medicine coupled with science. The Hmong understand the causation and treatment of illness in the context of their traditions and how healing actually takes place in the context of religion and spirituality.

Health issues

The book’s themes revolve around health issues coupled with how cultural differences amongst patients, patient’s families, and medical professionals may influence the treatment process. The entire story is about differing approaches to addressing health issues instigated by differing cultures (Yang, 1998). This aspect creates conflicts. American doctors perceive biomedicines as the only solution to Lee’s condition. On the other side, the Hmong consider traditions as the most appropriate mechanism of handling health issues (Vang, 2011). Seeking healthcare calls for trust in the ability of doctors to provide solutions to health problems. However, the history of Hmong Lee’s family back in their native land at refugee camps in Thailand erodes such trust. This aspect also affects their adaptation to the United States negatively, which gives them negative feeling about health care providers.

In the camps, the Hmong struggle with the interrogative “why American doctors eat brain, kidneys, and livers belonging to the Hmong patients” (Hillmer, 2010, p. 74). Their misinformed preconceptions of the Americans and their culture of processed foods also forces Hmong Lee’s family to mistrust the American doctors and the healthcare systems. They think that when the “Hmong people die in the US; they are sliced into small pieces, canned, and later to be sold as food” (Hillmer, 2010, p.74). This misconception explains why they take Lia to seek medical care when they think she has an emergency case.


The history of the Hmong reflects the heavy struggles and fights with people who claim sovereignty over their land. In the fights, giving up is tantamount to losing one’s sovereignty. Without the sovereignty, people have no life. Therefore, they had better die fighting. Fadiman (1997) writes, “Those who have tried to defeat, deceive, govern, regulate, constrain, assimilate, intimidate, or patronize the Hmong have, as a rule, disliked them intensely” (p.17). This assertion implies that the Hmong hate taking orders from anyone. Based on their immigration and conflicts with enemies, the Hmong cannot surrender, but they can flee or die fighting (Hillmer, 2010).

They do not also believe that other people’s cultural customs, no matter the superiority of the cultures, are better than their own. This tumultuous history plays the role of forming the Hmong culture’s in such a way that their norms and values do not permit them to integrate with foreign cultures easily. Therefore, Lee’s family cannot even follow doctors’ orders on how to administer medication to Lia.

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Medication as prescribed

Lee family’s reluctance to give her medicine as prescribed is incredibly sad and heartbreaking. However, this feeling depends on the understanding and inclination of the reader towards the two cultures. I believe in science and biomedical intervention for ailments. This aspect means I am inclined towards the American doctors’ approach to treating Lia Lee, but it is critical to appreciate that the Hmong have their own culture shaping their beliefs on causation and treatment of ailments. However, their lack of understanding on why their traditionally informed treatment approaches may fail to work for Lia Lee’s condition should not be treated as ignorance (Renée, 2006). This observation suggests that while the Americans believe that biomedicines would work for Lia Lee, it is also important to understand that this belief may not be necessarily true to the Hmong.

Doctors feel that Lee’s family members are wrong when they refuse to embrace their (doctors) diagnosis since they (doctors) strongly believe that they have the requisite knowledge and experience gained from many years of research and training in dealing with patients suffering from different ailments. The Hmong are opposed to biomedicines, but they embrace herbal medicines in the treatment of all ailments. This interplay of differing approaches to healthcare between the Americans and the Hmong makes Lee’s parents to administer biomedicines to Lia in the wrong dosages. Indeed, the conflict causes Lia Lee to suffer from brain death, which affects the rest of her life. Nevertheless, by understanding that there is no cultural integration between doctors and the Hmong, the Lee parent’s motivation for failing to give Lia her medicine as prescribed is understandable

Health care providers

The doctor sees the Hmong Lee family as ignorant and uninformed. The patient, Lia, is not outspoken. Hence, the doctors do not point a finger of blame to her poor medication consumption tendencies. The main challenge rests on dealing with the family. At first, the doctors think of forcing the family to give Lia her medication as prescribed. However, Fadiman (1997) notes, “If [doctors] continue to press their patients to comply with a regimen that, from the Hmong vantage, is potentially harmful, they may find themselves, to their horror, running up against that stubborn strain in the Hmong character which for thousands of years has preferred death to surrender” (p. 51). Indeed, the Lee family thinks that the medicines are not appropriate for Lia, which potentially makes her even worse. At one time, Lia is placed under foster care, with the goal of ensuring that she is medicated properly.

The Hmong Folktale

At the end of chapter twelve, Fadiman (1997) narrates folktale on how Shee Yee engaged in a fight with nine brothers (evil dab brothers). This narration reflects on the Hmong culture since it depicts the manner in which Shee Yee fought courageously without giving up. It reinforces the Hmong’s values and norms in matters of struggle for sovereignty. The folktale highlights the belief that no matter the challenges and obstacles encountered by the Hmong, there is always a way out. It also shows the manner in which the Hmong are fierce and courageous when handling enemies.

The folktale also suggests that the Hmong way of handling enemies is the smartest. As the enemy changes strategy, the Hmong also change strategy without contemplating giving up until the enemy is defeated (Johnson, 1992). Shee Yee faced challenges in the fight, but he was smart in making his moves. In the end, he was successful in defeating the enemy, which reinforces the norm of no surrender in the Hmong culture.

American Doctor

Hillmer (2010) posits that in “matters of attitude, an average American doctor can learn from the Hmong txiv neeb and consider cultural barriers while delivering healthcare in a multicultural society” (p. 77). Doctors need to spend ample time with their patients for better understanding between the two. This way, doctors can learn to integrate spirituality coupled with religion in their medical practice. They can also learn that herbs can equally cure ailments. In addition, doctors should avoid the overreliance of biomedicines in treatments; on the contrary, they should also consider shaman’s way of treating people. Biomedicines failed to work on Lia Lee. However, blending biomedicines with herbs could have worked. Txiv neeb can also learn not to treat other people’s ways of solving healthcare problems with ignorance. Additionally, they can learn how to employ biomedicine used by doctors to treat their patients.

Foster Parents

The kind of concern and tenderness from Lia’s surrogate parents is amazing. While I anticipated Lia to receive the best care and affection from her family, the foster parents also prove that they can offer a care of equal magnitude. With such loving and caring foster parents, foster care is meant to benefit Lia in terms of her healing. In fact, the reason why the doctors refer Lia to foster care rather than being with her parents is to ensure that she is medicated according to the prescriptions given at the Mercer Hospital. Unfortunately, foster care turn out to be detrimental. Lia suffers more seizures than when she is with her real parents.

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Jeanine Hilt

Jeanine Hilt, a caseworker, becomes the sole American to convince the Lia’s family and win their trust. Although many attempted and failed, she wins their trust due to her character. She is not judgmental and she takes time to listen and understand the Lees. Many doctors fail to do this as they think they are the only ones who ought to be listened. Unlike the doctors, Jeanine Hilt is interested and genuinely wants to understand the Hmong and their culture. Consequently, the Hmong Lee family sees her as friendly and easy to assimilate into their culture.

The mute Lia

The book’s protagonist is a small child, too young to voice her concerns. Although, even at the end, she is not able to speak, after reading the book, I think I know Lia Lee to some extent. Many issues defining her experience are narrated in the book despite the view that characters in the book do not understand them. Fadiman (1997) puts Lia’s experiences in a perspective that reader, who is alleviated from the world of the characters, understands. Through the book, her experience at the hospital and foster home is well explained. Although she is unable to talk, she is of incredible value to the doctors and the Hmong people. She acts as a reminder to the parties with opposing cultures coupled with legal systems that their cultural differences can cost even the life of an individual.

Personal opinions on Lia Lee and her personal struggles

Lia Lee is a passive character in the book. She is the tool and the only available opportunity to breach the cultural barriers between the American doctors and the Hmong people. However, she cannot make a decision on her preferred way of treatment. Her personal struggles to integrate the two cultures so that her condition can improve only ends without any achievement. Doctors place her under foster care, but she experiences more seizures amid medications following the given prescription.

In my opinion, this struggle suggests that biomedicines cannot cure Lia’s condition. This assertion holds as when her parents mix them with traditional medicines such as herbs, she never experiences seizures in the threshold similar to that she experiences when placed under foster care. In a bid to honor the personal struggles of an innocent and young person whose life is at stake due to cultural differences, which can be resolved, I think blending of American and the Hmong methods of treatment is necessary.


Fadiman, A. (1997). The Spirit Catches You and You Fall Down. New York, NY: Farrar, Straus and Giroux. Web.

Guerrero, S., Laughrea, S., McVicker, B., & Bradley, L. (2002). The Spirit Catches you and you fall Down. Web.

Hillmer, P. (2010). A People’s History of the Hmong. Minnesota, MN: Minnesota Historical Society Press. Web.

Johnson, C. (1992). Dab Neeg Hmoob: Myths, Legends and Folk Tales from the Hmong of Laos. Minnesota, MN: Macalester College. Web.

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Malina, D. (2005). Compliance, Caricature, and Culturally Aware Care. New England Journal of Medicine, 35(3), 1317-1318. Web.

Renée, F. (2006). Cultural Competence and the Culture of Medicine. New England Journal of Medicine, 31 (2), 1316-1319. Web.

Vang, C. (2011). Hmong America: Reconstructing Community in Diaspora. Chicago, IL: University of Illinois Press. Web.

Yang, Y. (1998). Practicing Modern Medicine: A Little Medicine, a little neeb. Hmong Studies Journal, 2(2), 1-7. Web.

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