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The Spirit Catches You and You Fall Down
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Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty--and their nobility."

Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.

Customer Reviews:

  • Who decides?
    Have a book discussion group that likes to read non-fiction? This is a biography of a Hmong child (a culture whose origins are in China/Vietnam) with a rare and profound seizure disorder, her parents, and her doctors. The story, told from multiple perspectives, brings out issues of immigration (The Hmong aren't "assimilating" well? Why not? Should they?), medical ethics (Who decides what care this child should have?) and spirituality (What should the doctors make of the spiritual beliefs of the family? What should the parents make of the medical claims made by the doctors?) This is a hard book, with no clear answers. If you are sitting down with it, you are accepting a challenge. Like any challenge, it has its rewards, but be prepared to be a little unsettled after reading it....more info
  • Catch the Spirit
    Reading this extraordinary book has helped me retrieve a significant part of my soul. A deep gratitude to the author for the tremendous sensitivity, involvement and work required to write such a thorough anatomy of the limits of communication for which the Hmong culture versus the American, and epilepsy versus "normalcy" are such strong metaphors. ...more info
  • A well-written account of culture clash in America
    Though certainly not perfect, Ms. Fadiman does an excellent job of describing the tale of Lia and the Lee family's interactions with the American health care system while allowing bias to show but somehow to balance in the end. It is very well-written and worth reading. ...more info
  • One of the most remarkable books I've read
    I don't keep many books for my permanent library, but this is one of them. It is a remarkable study of the meeting, misunderstanding, and ongoing struggle for harmony between Western ways and the unique culture of the Hmong people. The title story is only part, though a major one, of the book; a young Hmong girl became epileptic, and the long-running encounter of her family with Western medical traditions, hospital procedures, and cultural assumptions, occupies the greater part of the text. The story shows in many poignant ways how good intentions could not overcome radically different world views. Just how great the misunderstanding was (on both sides), can be glimpsed by an example: the author refers to "...the kind of blind spot that made a Merced health department employee once write, about a child from a family that views the entire universe as sacred:

    Name: Lee, Lia
    Principla Language: Hmong
    Ethnic Group: Hmong
    Religion: None"

    The Hmong are animists, regarding all things as having spirits, especially, the characterization of them as having no religion is laughable--but also tragic. The outcome of this young girl's affliction was similarly tragic...not only for her, but for her family, her doctors, and the Western friends who tried in various ways to be helpful.

    I strongly recommend this book to anyone who wants a brilliant example of how cultural assumptions and misunderstanding can play out in damage and pain to people on all sides of the interaction. It is sad but not pointless to consider a book such as this; it can only prove instructive and will ultimately help any number of people to better understand and coexist together....more info
  • ...
    This book is an eye-opener in the sense that it really makes you see the issue from both sides: one minute it inspires the reader to be empathetic with the Lee family and angry at the doctors and the next minute be empathetic with the hospital staff and angry with the Lees.

    As someone going into the medical profession it really made me aware of an aspect of medicine - the collision of cultures - that I had naively not even considered an issue. It also made me question if I could handle this type of situation and what I would do if I were in the position of the doctors - or even in the position of the parents.

    All in all, a good and recommended read.
    ...more info
  • Hmong Book
    The Spirit Catches You and You Fall Down
    Never received the book. Was very upset. Would never utilize a 3rd party buyer again. A complete waste of my time. ...more info
  • Fascinating study of the important role cultural competency plays in Western medicine
    A very interesting and detailed look into the life of this young Hmong child and the important role that cultural barriers played in her medical care. A wonderful account from both points of views. I would say this is a must read for any doctor....more info
  • Superbly written, heartbreaking nonfiction
    The story of the little Hmong girl caught between two clashing cultures to her great detriment made me weep with sadness and frustration at our American medical system. The book was in a strong, clear, matter-of-fact style which made the tale even more horrifying. I highly recommend this book to anyone with an interest in medicine or an interest in learning about new cultural belief systems. Merced, California is also a character in this book. A great read....more info
  • A must read for anyone entering the healthcare sector.
    This book is a wonderful telling of both perspectives (doctors ans social services vs. the patient's family) from the healthcare and cultural issues, clashes, and understandings of a foreign family in the American healthcare system. This book will help professionals and students entering the healthcare field to better understand that cultural differences don't have to be roadblocks in their treatment plans. Learn to understand your patients better and you may learn how to better treat their medical needs. It is also a good read for anyone seeking to better understand the issues that foreign families face when being forced to aclimate to American cuture and society....more info
  • Incredible true story!
    East clashes with West in regards to pediatric patient with seizures and treatment. Very educational culturally and medically. Moving. Great book, highly recommend!...more info
  • This is a great book!
    This is a great story, and my experience with this seller was good as well.
    I was a expecting a boring read since it was recommended for my graduate class, but I was pleasantly surprised....more info
  • Fascinating, tragic
    Well-written, gripping, thoughtful, thorough investigation into the tragic and seemingly unavoidable events in the life of a sick young girl and her loving family. Everyone wanted the best, but it all went terribly wrong. A compelling example of why we all need to keep learning from each other. ...more info
  • The Spirit Cathces You and You Fall Down
    The Spirit Catches You and You Fall Down is the story of a Hmong child diagnosed with epilepsy and her family's journey through a conflict between Western medicine and Hmong traditional health beliefs. The family escaped as refugees from Laos to be resettled in Merced, California. The conflict began when Lia experienced a seizure at 3 months old and was taken to the emergency room. Her medical team, based on the Western medical model, believed that Lia had epilepsy and could be treated adequately with anticonvulsants. Her parents believed her illness was qaug dab peg, described as the spirit catches you and you fall down. They believe the cure involved animal sacrifices and Hmong shaman medicine men. Lia's story was a description of a tragic case of miscommunication and lack of understanding of the family's cultural philosophy. Her uncontrolled epilepsy ultimately led to brain death at age 7. The author, Fadiman, presented the content in a narrative, non-opinionated way. The information is reliable and credible. Fadiman appears to have written the book to encourage a change in the policy of most healthcare providers to seek understanding and incorporate culture beliefs into their care. The American Nurses Association's Code of Ethics states that "the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual." The story of Lia brings this statement to life. Through Fadiman's writing she gives examples for healthcare providers to develop in their practice...compassion and respect for others and their values. Policies have move to provide translators for patients, however, Fadiman may believe there is more work to do. Developing compassion and respect for others can be taught. On a scale of 0-5 this book is a 5.
    This is an outstanding book that gives a personal story as an example of why healthcare policy should change to do more than just provide a translator, but a deeper understanding of others' cultures with respect. This book should be required reading for nursing students and healthcare professionals. Anyone interested in healthcare and culture would enjoy this book.
    ...more info
  • Important well-written book, but I couldn't finish
    I bought this book on the advice of many professionals (nurses, professors, social workers) who rave about it. It deserves the raves and it did teach me a lot. But, about two-thirds of the way through, I just couldn't take it anymore. Make sure you are ready to trudge through a history that goes from bad to worse. I, however, may be too close to the subject. The social worker portrayed in the book plays a dual role where she has the child removed from the home and simultaneously becomes a champion (albeit ultimately ineffective) of getting the child proper medical care and subsidies for the family. I am a social worker of many years and I found myself despairing about my own profession. Important book, I repeat! Cautionary tale that needed to be told and is told very well. Not a light read by any stretch of the imagination....more info
  • thought provoking
    marvelous book, well worth a thoughtful read; a little Hmong girl caught between well-meaning medical establishment and traditional culture. In microscopic detail shows how caring is not enough--cultural knowledge and understanding is needed as well. The author did a remarkable job, not only is the research impressive but the book is a great read. One of the best books I've read this year. ...more info
  • A Must Read for Medical Professionals, but an Excellent Read for Everyone
    The Spirit Catches You and You Fall Down by Anne Fadiman is simply an excellent read. Fadiman skillfully describes the collision of two worlds, western medicine and traditional Hmong culture, by using the case of one little girl as a springboard to explain the historical, cultural and spiritual background of this collision. As these two cultures had to coexist for optimal treatment, the reader is shown honestly and sympathetically how difficult that coexistence can be to develop and maintain.

    For me, the book's greatest merit is how Fadiman weaves the historical, sociological and anthropological background into Lia's story so well that it reads almost like a novel. It's informative, but also powerful, personal and thought-provoking. As a westerner, Fadiman is sympathetic to the doctors, their training and their perspective, but at the same time, she isn't afraid to criticize them or the Western medical system. This book was highly recommended to me (thanks Charlene!) and I would pass it along with the same high recommendation. Even if learning about the Hmong isn't high on your list of intellectual pursuits, I found a lot of the same observations and lessons about medical care were applicable to families who prefer alternative and natural treatments, a growing population. It's truly a must read if you are in any medical field, and a good read no matter who you are. ...more info
  • Informative
    This book was required summer reading for my college. I'd never heard of the Hmong people before reading it, and the story was definitely eye-opening. It's informative, but not too engrossing, so be prepared!Oh, also don't expect a happy ending to this one. However, the book is thought-provoking, which I think was its purpose. Mission accomplished....more info
  • I had no idea
    I had no idea these people even existed, I think that is what really weights on me. How uninformed I was, and still am, on so many levels. I appreciate that I now have a new perspective on not only what it is like to work with different types of people but also what it is like to come into a different culture to live. I feel alarmed, but not surprised, at the terrible way our government and people treated and are treating these people. I am also alarmed at my own ignorance. ...more info
  • A noncompliant incommunicative family's disease-related beliefs clash with those of conventional medicine-practicing doctors.
    At three months of age while living in Merced, California (where 20% of the residents were Hmong, 80% of those received Medi-Cal benefits, and most felt they were entitled due to their military involvement in Laos on the side of the U.S.), favored daughter Lia Lee (born July 19, 1982), the fourteenth child of Hmong refugee couple Nao Kao and Foua suffers her first epileptic seizure. The cause of her neurological condition, explained by the Hmong by the phrase used as the book's title, is attributed to "soul loss," resulting from a sister slamming a door preceding the episode. Due to a lack of communication between the physician and Lee family, who do not speak English, and the fact that Lia was no longer seizing when they sought treatment, she is diagnosed and treated for a bronchial infection. Not until March of 1983 during a third visit to the same reputable county hospital (MCMC) with Lia experiencing a grand mal seizure, is the correct diagnosis, of which the Lees are already well aware, made. Later, married pediatrician MCMC employees Drs. Neil Ernst and Peggy Philp, who provide much of Lia's care during subsequent visits, alternately treat her; determined to fine-tune her meds and compel the parents to administer them correctly. Of the pair, author Fadiman, writes: "Neil never visited their [Nao and Foua's] home...and Peggy visited only once;" "[They] were...six two and five nine...and had...perfect posture;" "[They] had no idea what the Lees were doing to heal Lia because they never thought to ask;" "[They]...never volunteered their first names [to the Lee family]." The author's opinion of the unarguably competent pair is as biased to the negative as her unfailingly faultless feelings towards the Lee's social worker are biased to the positive. Events leading up to an almost year long transfer of Lia to foster care (the goal being- achieving parental compliance with the proper dispensing of medicine), life with the foster family, a catastrophic bout of sepsis and the aftermath-notably including the almost miraculous, almost beyond reproach treatment and care provided, and transformation and healing achieved by the Lees are are detailed. Additionally, facts about the Hmong: history, culture, and religious beliefs and practices are included. Although Fadiman readily admits that Lia would probably not have survived beyond infancy without the intervention of western medicine (to the tune of $250,000 plus hospital-employee salaries in free medical care), she lays the blame for the girl's ultimate condition squarely on the shoulders of the treating doctors. A compelling though biased story of a clash of cultures in beliefs about the causes and treatment of diseases.
    ...more info
  • Cultural / Medical Clashes & A Charming Toddler
    Anne Fadiman tells the story of little Lia Lee, a Hmong-American child with epilepsy, and weaves together the woof of parental love and biomedical treatment with the warp of Hmong and American cultures. This book brings into focus how extensively cross-cultural transitions impact both the approaching and approached peoples. In an interview in 2001, Fadiman explains what drew her so deeply into this book, "Yes, it is about an epileptic Hmong toddler, but it is also about many other things. . . I started pulling on a slender thread, the thread that was Lia Lee, the small sick child . . . I pulled on the thread and the thread became a string and the string became a rope, and then I tugged really hard on the rope and I discovered that it was attached to the entire universe."

    Fadiman alternates chapters about Lia with chapters on the history and culture of the Hmong people. Interwoven in Lia's story is the story of her people. The parallel can be drawn that the spirit catches the Hmong people with wars and threats of assimilation, and in response the Hmong eschew resistance and migrate. Most of Merced's Hmong population came to the U.S.

    Lia's parents wanted "a little medicine and a little txib" (p. 110.) While medical care at MCMC was provided at no charge, Lia's family spent large sums on buying amulets, having a tvix neeb perform ceremonies, and sacrificing chickens, pigs, and even a cow. Foua would grow herbs and make special concoctions both for feeding to Lia as well as bathing her. The author was privileged to be present when the family sacrificed a pig in their living room in order to seek her wandering soul and bring it back to Lia.

    From the doctors' perspective Neil Ernst said, "I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids' lives" (p. 59.)

    The Spirit Catches You and You Fall Down was both thought-provoking and emotionally rewarding. It is recommend for those who enjoy a well-told story, as well as those working in public health fields, interested in cross-cultural transitions, or who have special interest in the Hmong people.

    Anne Fadiman discussed Lia Lee with medical anthropologist Arthur Kleinman. His observations brings out the crucial point (p. 260), "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?"

    Where is Lia Lee now? In a Newsweek article in 2005, then 22 year old Lia was still in a persistent vegetative state, still cared for at home by her careful and loving mother....more info
  • A very interesting book
    This book is very well written and easy to read. I found that I couldn't put it down and read it in two short days. It was definitely a worthy read, and I learned a lot about the Hmong and about what cultural competency really means. I would recommend this book to any physician, medical student, nurse, any medical professional or anyone interested in going into a medical profession. It will definitely teach you something.

    Overall, the author was more balanced in its portrayal of both sides of the story than I had expected. She was clearly more forgiving of the Hmong than I think was really fair. For example, I find it hard to forgive "rape and kidnappings" where "the woman was truly objecting" as a "misunderstanding".

    The author was definitely too hard on the doctors, who by my account were exceptionally dedicated physicians. You would be hard pressed to find a pair of doctors who committed so much time and energy to the care of a child, getting called at all hours of the day and night, for so little pay. The author writes that "Neil," one of the doctors treating the little girl, "never visited their home". When was the last time your doctor visited you at home? I think the doctors clearly could have handled the cultural differences better, but they tried very hard to take care of this child. Honestly, it sounds like this girl had such bad seizures that I doubt that anything would have really made a difference; a little sooner or a little later, I can't imagine that this would not have been the same outcome.
    ...more info
  • Eye opening cultural collision
    An eye-opening tale of immigrant cultural beliefs about illness and autonomy that collides with (well intentioned) American medicine. We (medical practicioners) tend to view our way of doing things as "right and good" and anything else as wrong. Fadiman does a good job of helping the layman to understand the situation and outcomes. Great read for anyone in the healthcare field. ...more info
    Had to read this book for school... it took everything I had not to throw it in the fireplace and turn it to ash. What a ridiculous thing to write about - foreigners who can't read or write English & their child is hurt. Compassion for child? Yes. Compassion for parents? No.
    This is a boring read.. move on to something else if this is not a mandatory read....more info
  • Makes you think
    I'm just your run of the mill American and I never thought about how our pretty Western medicine isn't what everybody on the planet absolutely strives to attain. This was an eye opening read that I reccomend to anyone who believes that what we have here is the end all be all when others think otherwise. ...more info
  • Great read and hard to put down!
    I bought this book as part of my coursework in Public Health Nursing. It is a wonderful book. It speaks to our general lack of cultural awareness from the medical community standpoint. It also opened my eyes to a strong and brilliant culture (Hmong). I am glad that my instructor recommended this book. ...more info
  • made me think, but also made me furious
    This is a well written book on a very interesting topic about the difficulties that immigrants face who are brought from basically "stone-age" to the modern American society. The story is centered about a Hmong child with what looks like one of the "catastrophic epilepsy of childhood" and definitely not the kind of benign Rolandic epilepsy that children outgrow without long term sequelae by the time of puberty.

    It made me think about cross-cultural differences and ways to solve this problems, however several questions kept popping up when reading this:

    1. if Lia's family distrust Western medicine so much, why on earth keep they bringing her back to the hospital's ER over and over again? the author never addresses this question.

    2. what would have been the outcome of Lia's epilepsy had they stayed in Laos without any medical treatment? she most likely would have died shortly after the disease's onset in prolonged status epilepticus or her cognitive abilities would have slowly but steadily regressed over the years due to the seriousness of her illness leaving her in a permanent vegetative state.
    The author never mentions this either.

    and in the last chapter of the book the author really loses it when comparing the "American and the Hmong way" culmulating in the following passage: "Once several years ago, when I romanticized the Hmong more (though admired them less) than I do now, I had a conversation with a Minnesota epidemiologist at a health care conference. Knowing she had worked with the Hmong, I started to lament the insensitivity of Western medicine. The epidemiologist looked at me sharply. "Western medicine saves lives", she said. Oh. Right. I had to keep reminding myself of that."...more info
  • Exceptional and comprehensive look at Hmong beliefs and history
    It is a rare experience that I pick up a book and cannot put it down. The Spirit Catches You and You Fall Down is deeply insightful into the thoughts and mindsets of the Hmong people in America. They can be quiet, polite, and reserved, even if they plan to be non-compliant with the administration of Western medicine, or even if they do not understand a doctor's instructions for administering pills.

    The book demonstrates the tremendous barriers this cultural group has faced since coming to the United States from 1976 on, and background about what happened to them.

    Of course, the center of this book's controversy is Lia Lee, an infant in arms when we first see her, She suffers from a severe form of epilepsy, but is someone who beats the odds and remains alive long past her doctors' predictions.

    Even though she is in a "vegetative" state, the little girl is kept "immaculate," sleeps with her parents, and is carried around on her mother's back in the largest baby carrier anyone has ever seen, all proof of the extreme love that is showered upon Hmong babies. They are considered a treasure, no matter what.

    The story is heartbreaking, compelling, and written with expertise, wisdom, and understanding.

    I highly recommend this book to anyone who wants to better understand the "Secret War in Laos" and all of the ramifications it has wrought, and who will take the time to try to understand the challenges of one Hmong family, on a deeply personal level.
    ...more info
  • The Spirit Catches You and You Fall Down
    Ann Fadiman is an incredible writer and this book is superb, not only for people in the medical profession, but any lay person interested in the culture of, and barriers facing, immigrants in the U.S....more info
  • An important lesson in Cultural Psychology
    This book is an excellent illustration of the importance of cross-cultural competence in the practice of psychology, education, and healthcare. After reading this book, I cannot imagine a case where any professional could walk into a situation with a client from another culture and fail to take stock of cultural factors.
    The story beautifully illuminates how culture 'colors' all of our experiences, impressions, and perceptions. ALL practioners should read this book and take heed in professional practice. Further, because this book only highlights the challenges for professionals with ONE culture, there is a message between the lines that all cultures require this deep and specialized look at the values and norms therein....more info
  • The Spirit Catches You and You Fall Down
    This was an wonderfully written nonfiction book that offers insight for helping professionals working with the Hmong population. The author gives a detailed account of how cultural and communication barriers affected medical treatment for a Hmong child. The outcome for this child and family could likely have been different had the professionals understood more about the Hmong culture and had been able to communicate with the family, incorporating their beliefs and understanding of the child's diagnosis. This book reminds helping professionals that utilizing an interpreter with cultural brokering skills is beneficial for everyone involved....more info
  • a real eye-opener
    A fascinating case study of a Hmong family's profoundly frustrating encounter with a county medical center in rural California. The book is very well written, and gave me fresh insight into what it really means for us to be a "nation of immigrants." My only frustration was with the organization of the book. As it jumped backed and forth between the micro and the macro, and between the recent and more distant past, the narrative lost some of its momentum. But that said, it is one of those rare books that has made me look at the world in a new way, and for that reason, I highly recommend it. ...more info
  • Came damaged
    Because this book came along with two others, one which was quite huge and heavy, the book cover was damaged when it arrived. Other than that it arrived within estimated arrival time....more info