The Spirit Catches You

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The Spirit Catches You and You Fall Down:
A Hmong Child, Her American Doctors, and
The Collision of Two Cultures
By Anne Fadiman
Farrar, Strauss and Giroux 1997 341 pp

Anne Fadiman was on NPR recently talking about her latest book, a memoir that sounded somewhat interesting—but my ears perked up at mention of the title of a previous book of hers, The Spirit Catches You and You Fall Down, a phrase meant to describe seizures. I don’t read everything on seizures I can get my hands on just because my son has them—but this book’s title promised an alternative perspective. I was not disappointed. Not only does Spirit… offer a new perspective on seizure disorders, but on Western so-called civilization itself, and most particularly Western medicine.

I doubt there’s anyone alive today who doesn’t harbor at least some ambivalence towards medicine as it’s practiced in the United States, and I’m not talking about bills and insurance. When my son was newborn and diagnosed with hydrocephalus, my husband and I gathered second and third and fourth opinions by taking him to every neurosurgeon anyone we knew recommended within a hundred-mile radius. We would sit in these doctors’ offices, I as the caretaker feeding or comforting my days-old infant while the important business was discussed by the men. At some point during the consultation the doctor would stand, tape measure in hand, and come measure my baby’s head. Then he would take his meaty hand and push down on my baby’s fontanel. I, who’d been raised with fear-tinged admonitions to never touch my baby cousins’ ‘soft spots,’ nearly fainted: I was convinced the doctors were mad.

That is how Foua and Nao Kao Lee felt about the doctors at Merced County Community Hospital who tended to their baby daughter Lia when she started having seizures. Whereas I worried about damage to my baby’s head, the Lees worried about damage to Lia’s soul. In the Hmong culture, sickness is a signal of a disturbance to the soul, the most extreme form being the soul’s wandering. To the Hmong, healing is a matter of tending to the soul. When did you last see an American doctor do that?

Even had the doctors who cared for Lia known of this basic tenet of the Lees belief system, they probably wouldn’t have given it any consideration. As things were, they knew little about their patient’s family: not only did the Lees not understand English, but their culture is so far from that of anything remotely American, the doctors hadn’t the ears to hear, eyes to see, or consciousness to absorb Hmong beliefs. To them, as to many Americans, the Hmong are a “Stone Age” people, ignorant and superstitious. Certainly Hmong rituals and healing ceremonies are strange and arcane—but no stranger than those of the Catholic or Jewish faith: all utilize symbols, whether it’s wine standing in for the blood of Jesus, drops of wine spilled onto a plate for Egyptian plagues, or a wooden bench transformed into a winged horse carrying a healer in search of a sick person’s soul. Why is it that the good citizens of the United States laugh only at the latter?

Writer Anne Fadiman decided to look at American medicine through the prism of Lia Lee’s sad story. She discovered, and imparted to readers, the rich depth of Hmong culture, devoid of sentimentality. Fadiman is careful not to imbue the Hmong with the kind of romanticism that European Americans tend to hold about Native Americans: she does not evade showing how difficult and intractable they can be. By allowing them full humanity, she brings them vividly to life the same way a novelist does her characters—Spirit, though non-fiction, is as compelling as a good novel.

The Hmong came to America in the 1980s courtesy of war in Southeast Asia. They’d been living in the mountains of Laos, to which they’d previously migrated from China: the Hmong have never assimilated into the dominant culture of the country they inhabit, and have suffered persecution for centuries. Much like the Roma or the Jews, they’re a migratory tribe without a homeland—but I doubt they ever felt quite as displaced as they did when they got to the United States. Because they helped the CIA in Laos, the Hmong were promised they’d be welcome in the U.S.—but when the troops left, they jetted only generals and hotshots out of the country, leaving the rest of the populace to fend for themselves. With the Laotian army hunting them down as enemies of the state, Hmong families set off on foot, carrying whatever they could manage. Many, particularly the old and the young, died along the way. Most possessions were shed, too heavy to carry, on the days-long journey. When they arrived in Thailand they were placed in refugee camps, where they waited to be rescued by the Americans. Those who were brought here were ‘resettled’ all over the map, without regard for family cohesion or transferability of survival skills: in Detroit, Minneapolis, Utah, Vermont—the Hmong were distributed all over the country so as not to unduly ‘burden’ any one locality.

The Hmong are a family-intensive culture. They tend to have large families of 12 or 13 children, who they deeply adore—even children with disabilities, who they view as a consequence of some parental transgression, and who must be treated kindly as a means of atonement. Families are organized into clans. Marriage among clansmen is strictly taboo—so living among only one’s own clan is problematic. They’re used to living near relatives, who they see frequently, if not daily. The diaspora of the Hmong presented unspeakable hardship—which they ingeniously resolved with what they call their ‘second resettlement.’

A Hmong family, oppressed and bewildered by urban living, would simply pack up a hastily purchased old car and drive, in search of a hospitable spit of land on which to grow vegetables and the herbs necessary to their healing rituals. They’d end up where all pioneers do, in California, and send news to other parts of the family in Detroit or Chicago or Billings, Montana. Eventually, pockets of Hmong were clustered in a few locations around the country. Of these, Merced, California, where the Lee family settled, is one of the largest.

About one in every six residents of Merced, formerly an all-white rural area, is now Hmong. As they’ve done throughout the centuries, they developed their culture and community parallel to the dominant one, assimilating as little as possible. One way in which they had to assimilate, at least partially, is medically: social services watch over these families and how they treat their children (80% receive some form of government assistance). American social workers do not have a high level of tolerance for cultural difference as it is. Many Hmong practices, like gardening on the living room floor and animal sacrifice, can put parents precariously close to losing their children to foster care—an unthinkable consequence that did occur, for a period of time, to Lia Lee.

Hmong healing ceremony

Before they even got to these shores, the Hmong had heard about Western medicine. They’d been privy to the wonders of antibiotics, of which they approved: swallow a pill and get well in a week. They did not approve of much else. Surgery was anathema, since cutting the flesh or removing organs risks the flight of the soul. When their daughter Lia fell into the hands, as they saw it, of the medical establishment, the Lees suffered deep agony with every medical procedure, from IV insertion to spinal taps. I couldn’t help but remember my own experiences: the pushing on the fontanel, which to this day makes my stomach queasy; the insertion of dye into my baby’s head so fluid blockage would show up on an X-Ray; starvation prior to surgery; and the five-hour operations: although I didn’t actually see the latter, I did feel them. I know what the Lees endured. For them it had to be a thousand times worse, what with their inability to understand the doctors’ explanations. (In studies the Hmong rate “difficulty with American agencies,” social as well as medical services, a more serious problem than war memories or separation from family.)

Fadiman explores the interactions between the Lees and Lia’s medical caretakers in exhaustive detail. Whenever Lia suffers a setback, the Lees blame the doctors and their methods. The doctors accuse the Lees of “noncompliance,” for instance, when they fail to properly dose Lia with the three different kinds of anti-convulsants at the various times of day that they prescribe (The Hmong don’t even utilize clocks). Fadiman presents a balanced picture, blaming neither the family nor the hospital, but cultural barriers, for what goes wrong—and eventually things do go terribly wrong. By the age of four Lia is brain dead. The hospital hooks her up to feeding tubes, expecting her to die within days, but the Lees insist on taking her home, where they disconnect every tube and treat Lia as a favored family member. They take turns carrying her around on their backs; like a mama bird, Foua pre-chews her daughter’s food and feeds it to her orally; they sacrifice pigs in healing ceremonies; and Lia sleeps with her parents every night. To the astonishment of the medical community, Lia doesn’t die; by the end of the book, years after being declared brain dead, she’s still alive (I suspect she’s died by now).
(Update: Lia Lee is still alive and still lovingly cared for by her mother and siblings. Her medical condition has not changed. Her father, Nao Kao Lee, died in January of 2003. For more information, here’s a website on the book.–MS)

In trying to summarize The Spirit Catches You and You Fall Down, every thought that pops up leads me to another; it’s impossible to convey every aspect in one review. This book enriched and possibly changed me. The same may happen to everyone who reads it. Do.

Above photo from exhibit of portraits of Hmong women

Click here to read another blog on this book

Here’s a page filled with resources on all things Hmong.

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Filed under California, Disability, Health care, Hmong, Reviews