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.

Some American medical attitudes and practices will never be saved, no matter what kind of  “health care reform” Congress enacts. 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 recommended within a hundred-mile radius. At some point during the consultation the doctor would stand, tape measure in hand, and 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, but NEVER!, touch a baby’s ‘soft spot’ I nearly fainted: then and there I decided they 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 began having seizures. Whereas I worried about damage to my baby’s head, the Lees worried about damage to their child’s soul. In Hmong culture, sickness is taken as a sign of disturbance to the soul, and healing is a matter of keeping spirit and body integrated by tending to a wandering soul.

Even had the doctors who cared for Lia Lee known 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 had not 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 rather strange and arcane—but not any more so than those of the Catholic or Jewish faiths. All three religions utilize symbols, whether it’s wine standing in for the blood of Jesus or to represent Egyptian plagues, or a wooden bench used as a winged horse to carry a healer on a search for the sick person’s soul. Why is it that the good citizens of the United States laugh only at the latter ritual?

The Lee Family, above

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  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 and other indigenous people: 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 well-written 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—and yet, I doubt they ever felt quite as displaced as when they arrived in the United States.

For assisting the CIA in Laos, the Hmong were promised they’d be welcome in the U.S.—but when the troops left the country, they jetted only generals and hotshots out, 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 eventually shed.

When they arrived in Thailand they were put into 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 cherish—including those with disabilities. They interpret disability as a consequence of parental transgression, not in a punishing way but to teach a missed lesson; children with disabilities must, above all, be treated kindly. Families are organized into clans. Marriage within the same clan is strictly taboo—so living only among one’s own clan can be problematic. They’re used to living near relatives and seeing one another almost daily. For all these reasons and more, their diaspora represented unspeakable hardship.They ingeniously resolved some of these problems by making what  they call a ‘second resettlement.’

A Hmong family, oppressed and bewildered by urban living, would pack up a hastily purchased jalopy and drive in search of a hospitable spit of land to grow vegetables and the herbs necessary for their complex healing rituals. Many ended up where all American pioneers do, in California, and sent news to family in Detroit or Chicago or Billings, Montana. Eventually, pockets of Hmong were clustered in a few locations around the country, with Merced, California, where the Lee family settled, being one of the largest.

One in every six residents of Merced, formerly an all-white rural area, is now Hmong. They did what they’ve been doing for centuries–developed their culture and community parallel to the dominant one, assimilating as little as possible. One area in which they had to assimilate, at least partially, is medically: with 80% of Hmong receiving some form of government assistance, social workers paid close attention to them. American social workers do not have a high level of tolerance for cultural difference, and 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 occurred, for a period of time, to Lia Lee.

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 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 profoundly with every medical procedure, from IV insertion to spinal taps.

I couldn’t help but remember my own experiences: the pushing on my son’s fontanel, which to this day makes me 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. While I didn’t actually witness the latter, I most certainly felt them. I well understand  what the Lees went through, and 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, 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 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, the doctors think they’re purposely screwing up; they never bother to learn that the Hmong don’t own or use clocks.

Fadiman presents a balanced picture, blaming neither the family nor the hospital, but rather cultural barriers, for what goes wrong—and eventually things do go terribly wrong. By the age of four Lia is in a coma. 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 is still alive.

*Update September 27, 2009: For the latest available information on Lia, see comments below. If anyone has any more news, please do share it in the comment boxes.–MS.

It is impossible to convey every aspect of this complex culture in one review. This book enriched and possibly changed me. The same could happen to everyone who reads it. Do.

Above photo from exhibit of portraits of Hmong women

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

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Filed under Disability, Health care, Hmong, Reviews

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