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

*Please see update at the end of this post.*

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. Having been raised with fearful caution to never, NEVER!, touch a baby’s ‘soft spot’ I nearly fainted: then and there I decided these so-called doctors were madmen.

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 their child’s soul. In the Hmong culture, sickness is taken as a sign of disturbance to the soul, and healing a matter of keeping spirit and body integrated, primarily by tending to a wandering soul.

Even had the doctors who cared for Lia Lee 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 any of it. To them, as to many Americans, the Hmong are a “Stone Age tribe,” 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 three of these religions utilize symbols, whether it’s wine standing in for the blood of Jesus or spilled on a plate to represent Egyptian plagues, or a wooden bench used as a winged horse to carry a healer on the search for the 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 sappiness or sentimentality. Fadiman is careful not to imbue the Hmong with the kind of romanticism that European Americans tend to hold towards Native Americans: she does not avoid showing how intractable the Hmong people 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 1980’s 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 because of this they’ve endured much persecution. Like the Roma and the Jews, they’re a historically migratory people—but I doubt they ever felt quite as displaced as when they arrived in 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 possessions they could manage. Many, particularly the old and the young, died along the way. Most possessions were shed along the way.

When they arrived in Thailand they were placed in refugee camps, where they waited to be rescued by the Americans. Those who were finally brought to the States were ‘resettled’ all over the map, without regard for family cohesion or transferability of survival skills: Detroit, Minneapolis, Utah, Vermont—the Hmong were distributed all over the country so as not to unduly ‘burden’ any one locality.

The Hmong tend to have large families of 12 or 13 children, who they deeply adore—even children with disabilities. They interpret disability as a consequence of parental transgression, not in a punishing way but to teach some missing lesson; children with disabilities must be treated kindly. Families are organized into clans. Marriage within the same clan is strictly taboo—so living among one’s own clan only can be problematic. They’re used to living near relatives and seeing one another frequently, even daily. Thus, their diaspora represented unspeakable hardship—which they ingeniously resolved with what they call their ‘second resettlement.’

A Hmong family, oppressed and bewildered by urban living, would pack up a hastily purchased old car and drive in search of a hospitable spit of land to grow vegetables and the herbs necessary for their complex healing rituals. Many of them ended up where all American pioneers do, in California, and sent news to family members 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: since 80% of Hmong receive some form of government assistance, social workers closely observe the way these families treat their children. Now, American social workers do not have a high level of tolerance for cultural difference. Many Hmong practices, such as gardening in the living room and animal sacrifice, put parents precariously close to losing their children to foster care—an unthinkable consequence that occured, 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–but 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 profound 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 injection 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 themselves: although I didn’t actually see the latter, I most certainly felt them. I know what the Lees endured, and for them it had to be a thousand times worse, with their inability to understand the doctors’ explanations. (In studies, the Hmong rate “difficulty with American agencies,” social as well as medical, 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” when they fail to properly dose Lia with the three different kinds of anti-convulsants at the precise times of day prescribed, not knowing or caring that the Hmong don’t wn or use 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 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 September 27, 2009: For the latest available information on Lia, see the last comment, below. If anyone has any more news, please do share it in the comment boxes.–MS.

In trying to summarize The Spirit Catches You and You Fall Down, every thought that pops up leads to another; it’s impossible to convey every aspect of this rich and complex culture in one review. This book enriched and possibly changed me. The same thing could 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 Disability, Health care, Hmong, Reviews