This is an article that is truly very worthwhile reading.

It offers a fascinating account of the culture clash that occurs when different worlds collide.

The author delves deep into the various aspects of this clash, exploring the misunderstandings, the differences in values, and the challenges that arise.

We are taken on a journey through the eyes of the characters, experiencing their confusion, their frustration, and ultimately, their growth.

The vivid descriptions and engaging narrative make it impossible to put the article down.

It not only provides entertainment but also offers valuable insights into the complex nature of cultural differences.

Whether you are interested in learning about other cultures or simply enjoy a good story, this article is sure to captivate you.

So, don't miss out on this opportunity to explore the fascinating world of culture clash.

Pick up this article and prepare to be amazed.

Perhaps my boredom with the book can be attributed to mismatched expectations. I had not anticipated a book that was so dense with historical details and anecdotes. Moreover, there were an abundance of medical details that seemed rather inconsequential.

Overall, I believe the intention behind the book was good. The storyline, to the extent that it existed, was acceptable. The cultural descriptions were indeed significant and worthy of note. However, I did not take pleasure in the majority of the book, and as a result, I would not wholeheartedly recommend it.

It seems that the author's attempt to incorporate a wealth of information detracted from the overall enjoyment of the reading experience. While the historical and cultural aspects were interesting, they were perhaps presented in a way that made the book feel more like a textbook than an engaging novel.

Perhaps with a different approach, the author could have created a more captivating and enjoyable work that would have appealed to a wider audience. As it stands, I can only offer a somewhat lukewarm assessment of this particular book.

Having been raised in Saint Paul, Minnesota, where many of my friends were Hmong growing up, I was super intrigued when I heard about this book. There just aren't a lot of books available in English about Hmong culture, which I already knew to be exceedingly rich and one that has taught me a lot of lessons I carried into adulthood. So the excitement and anticipation was high for me.

I knew going into this book that the author was a white woman, but I was not prepared for just how white this book is. I do recognize that it was written in the 1990s, and that the 1990s had its own cultural context. However, the 1990s is also when I was living in St. Paul, and I had hoped that this book would center Hmong voice, avoid discussing Hmong culture in an exoticizing way, and avoid generalizing from a single family to a whole culture. Unfortunately, it failed on all these counts. From the first few pages, I wanted to skip to the Afterword and see if the author had any better insight into the cultural lens she brought to this narrative with 15 years of hindsight. I'm kind of glad I refrained, because if I had read the Afterword first, I would have set this book down and walked away.

There were also a great number of points in this book where the author makes subtle jabs at the broken English of the Hmong people, makes casual observations like "oh this person is actually really smart," elevates extremely offensive statements made by white doctors without commentary, and projects and speculates about what "a Hmong person" would think and about Hmong cultural beliefs from the role of an expert. It's constant and maddening. While she does take a favorable view of the Lee family over the doctors and talks to more Hmong people than just the Lee family, and rails against some of the bias and prejudice experienced by the Lees, it's really overshadowed by how she positions herself as the expert and accepts her worldview as neutral. I am very torn on recommending this one, especially in 2021 when there are other books about Hmong culture available in English by people who are actually Hmong.

With that enormous caveat aside, The Spirit Catches You and You Fall Down was a really gripping read for me. It centers on a young girl named Lia Lee, who had a severe form of epilepsy, her family, and her medical team in Merced, California in the 1980s. Lia began having significant seizures as an infant, but her parents were unable to explain that to medical staff when they brought her to the hospital each time because they spoke no English and no interpreters were available. It took several seizures before they could get her to the hospital while she was still seizing and convey the actual reason for their visit. Once Lia was diagnosed, her plan of care quickly became complex, as her condition was severe and her seizures were difficult to control. Her parents struggled to follow the medication plan, not because they didn't understand it, but because they were very concerned about the side effects they were witnessing. Unable to convey this to the doctors effectively, and unable to get the doctors to value their perspective on their own daughter's care, Lia was forcibly removed from her parents' home and placed into foster care.

Luckily, Lia seems to have mostly had a positive experience in care, including a caregiver who took a co-parenting approach with her parents, valued her relationships with her full family, and supported reunification from early in the case. The family also seemed to have a very strong positive relationship with the social worker. Lia was indeed reunified ten months later. But once home, Lia continued to experience seizures, although at fewer intervals, even with her parents following the medication plan. Her doctor grew very concerned that it was more or less inevitable that Lia would have a severe sustained seizure from which she would likely not recover, and indeed that happened when Lia was four years old after she suffered septic shock. From that point on, Lia continued to live to the age of 30 in a persistent vegetative state, eventually dying from pneumonia. The author interviews many of Lia's doctors, Lia's parents, and some leaders in the Hmong community to get different perspectives on Lia's illness, Lia's treatment, and the cultural barriers that, if addressed differently, could have saved Lia's life.

In alternating chapters, the author also explores Hmong culture more broadly, beginning with the history of oppression the Hmong have faced for generations upon generations long before leaving Southeast Asia. She offers a vivid picture of what life was like in Laos, how extensively the US relied on the Hmong to fight a proxy war in Vietnam, and the experience of fleeing to refugee camps in Thailand when the communists prevailed and their lives and livelihood were threatened for rising up on behalf of the US. She also gets into the very poor approach the US government took to resettling Hmong refugees in the United States. She goes into a lot of detail around some very specific Hmong religious beliefs, but others she glosses over or ignores completely. For a lot of this information, she seems to rely heavily on the work of Christian missionaries in the region.

Like I said, I was definitely engaged in reading this book and found it hard to put down, and I did get better insight into some parts of Hmong culture. However, I also was really upset by the tone of a lot of it. So read with discretion.

I had a slight acquaintance with this case. Before delving into the book, I was convinced that I would be filled with fury towards the Hmong family and hold nothing but disrespect for them, automatically siding with the American side. This was despite the fact that I also have my own reservations about the western medical establishment.

However, as I read on, I found myself not only feeling angry (and at times, even amused) with both sides, but also ending up empathizing with the people on both sides of this intense culture clash. This is a true testament to Anne Fadiman's masterful account of the events.

My culture is undeniably that of an American (well, a subculture within America, as there are clearly numerous cultures coexisting within the country!). I am rather attached to it. But I truly cherished this opportunity to peek into a culture so vastly different from my own.

Anne Fadiman does an outstanding job of presenting both sides of this story. It is perhaps one of the finest examples of cross-cultural understanding that I have ever come across. Ostensibly, it is about a young Hmong girl with epilepsy and her family's conflict with the American medical establishment, and there is a wealth of information about them here.

Moreover, it is also a wonderful history book. It provides extensive background on the Hmong people, stretching back centuries, as well as recent history. It also made me sympathize with the hardships of the immigrant experience, especially for those who settle in a place so foreign to their homeland.

I learned an incredible amount about the Hmong people. I knew very little prior to reading this book, and what I did know was often inaccurate or lacking in context. And as I read, I was truly struck by how cultural differences (and the cultural divide between the Hmong and American cultures is as wide as it gets) can completely impede communication if they are not recognized and efforts are not made to bridge the gap. This is an excellent book to read if you wish to attempt to understand any group of people who are different from you in any respect.

It is beautifully written and an absolute joy to read.

The Spirit Catches You and You Fall Down is the Hmong word for epilepsy. This story mainly follows a Hmong family who immigrated to the US and their conflict with the medical community. The cultural background of the Hmong people, including their history, world view, and self-identification, significantly contributes to understanding a people who are very different from western culture. There are so many people with the best of intentions trying to do the right thing, but so many cross-cultural misunderstandings lead to heartache. This book was written and took place in the 80s - 90s. The afterword by Hardiman in 2012 adds a message of healing and hope.

The Hmong people have a rich and unique cultural heritage that is deeply intertwined with their daily lives and beliefs. Their history of migration and settlement in different parts of the world has shaped their identity and influenced their approach to various aspects of life, including health and illness. In the context of the story, the Hmong family's understanding of epilepsy is based on their cultural beliefs and practices, which may conflict with the medical model used in the US.

The cross-cultural misunderstandings that occur between the Hmong family and the medical community highlight the importance of cultural competence in healthcare. It is essential for healthcare providers to understand the cultural background and beliefs of their patients in order to provide effective and respectful care. The afterword by Hardiman offers a glimmer of hope by suggesting that through dialogue, education, and mutual understanding, it is possible to bridge the gap between different cultures and promote healing and well-being.

It was indeed a fact that had the Lees remained in Laos, Lia would most likely have perished before she even reached the end of her infancy. This was due to a prolonged episode of untreated status epilepticus. In Laos, the lack of advanced medical facilities and resources would have made it extremely difficult, if not impossible, to provide the necessary treatment for such a serious condition.

However, in the United States, although Lia's life was preserved through the use of modern medicine, her condition was also compromised. The treatment she received may have had certain side effects or limitations, which could have had a negative impact on her quality of life and development.

I found myself in a state of uncertainty, wondering which of these two scenarios had hurt her family more. On one hand, if Lia had died in Laos, her family would have had to endure the pain of losing a child at a very young age. On the other hand, in the United States, her family had to deal with the challenges and uncertainties associated with her compromised condition. It was a difficult and complex situation, and I could not help but feel empathy for the Lees and the difficult choices they had to make.

Beautifully written and deeply insightful, this book is truly a gem.

It was crafted with a tremendous amount of empathy, which is palpable throughout the text.

The author's understanding and compassion shine through every page, making it a captivating read.

What makes this book even more remarkable is the afterword.

In it, the author addresses any potential issues that a reader might have with Fadiman's portrayals.

This shows a rare level of self-awareness and a commitment to engaging with the reader's perspective.

By doing so, the author not only clarifies any possible misunderstandings but also deepens the reader's appreciation for the book.

Overall, this book is a must-read for anyone who appreciates great literature and wants to gain a deeper understanding of the human experience.

Anne Fadiman presents a detailed account of the Lia Lee case, considering the perspectives of doctors, family, social workers, and other caretakers. However, while the book does a good job of exploring Hmong culture and beliefs about medicine and disease, it may have fallen into the trap of over-explaining. Fadiman's exploration of Hmong/Hmong-American culture and history as a whole sometimes feels like the Lees need to be "explained" rather than understood on their own terms.

The book fits well into the discussion of our cultural understanding of medicine and illness, along with other works like "The Emperor of Maladies" and "Illness as Metaphor". It offers insights into how medical culture and culture as a whole impact treatment development and disease outcomes. However, there is an assumption in the book that the actions of the medical establishment are understandable and do not need to be analyzed, while the actions of the Lees are attributed to the clash between Hmong and American cultures.
I found myself sympathizing with the Lees, as I recognized the dehumanizing feeling of being reduced to a bundle of symptoms. Fadiman's attempt to explain the Lees' actions through historical examples sometimes felt offputting, as it seemed to overlook the complex emotions and experiences involved. Overall, "The Spirit Catches You and You Fall Down" is a meticulous piece of journalism that explores an important topic, but it may not have fully lived up to my expectations.

Rating: 3.5 stars.

Admittedly, I knew nothing about Hmong culture or people before this book. This book was truly incredible in achieving its purpose.

However, there is one passage that could have been excluded from the book, and if that were the case, my rating would be 4.5 - 5 stars.

On page 162, Fadiman demonstrates that despite all her efforts to understand, empathize with, and be fair when examining Hmong persecution and their violent resistance to that persecution, she makes an aside criticizing Palestinian “terrorism”. She fails to name the attacks as resistance to Israeli colonialism and apartheid.

The phrase “progressive except for Palestine” immediately sprang to mind and made me question her expertise regarding this community. If she overlooks the oppression of one group, how much can she truly claim to speak for the Hmong?

It makes one wonder if her understanding and portrayal of the Hmong might also be influenced by similar blind spots or biases. This one instance casts a shadow over what was otherwise a remarkable and informative book.

Perhaps a more comprehensive and inclusive approach would have been beneficial to ensure that all forms of oppression and resistance are accurately represented and understood.

Nonetheless, the book still offers valuable insights into Hmong culture and history, and it is worth reading with a critical eye.

This book

sheds light on the clash of cultures and the misinterpretation of what is best medically for little Lia Lee. It vividly demonstrates two opposing views on how we view life. In Hmong culture, a person's physical and spiritual being is very different from that in the Western world. The book takes us through the numerous challenges Lia's family faces as they battle her epilepsy and its treatment. From their cultural viewpoint, they do what they think is fit, while the medical community is doing everything it can to find solutions to her medical condition in the way they would approach it. Anne Fadiman has skillfully interwoven the conflicts between the two approaches, the miscommunication, and how Hmong beliefs and values, which are basic and ingrained in them over thousands of years, are viewed suspiciously and skeptically by the doctors and the community.

To understand Hmong thinking and beliefs, Fadiman’s research takes us back hundreds of years to provide context and background. It goes to the Hmong covert assistance to Americans fighting Communism in southeast Asia, the subsequent flight of thousands of Hmongs, including Lia’s family, to the United States, and the barriers that Hmongs faced assimilating into the western community. This book is truly an eye opener to the challenges of communication, understanding a people’s belief systems, and what flexibility and creativity can really achieve when attempts are made to understand a different perspective. It offers a great reading and learning experience that enriches our understanding of different cultures and the importance of cultural sensitivity in medical and social contexts.

Just as relevant to a white teacher in the South Bronx in 2018 as to a resident at Merced Community Medical Center in 1986.

This statement highlights the enduring significance of certain issues or circumstances across different times and settings. In 1986, at the Merced Community Medical Center, there were likely specific challenges and experiences that were relevant to the residents.

Fast forward to 2018, and a white teacher in the South Bronx may face a whole new set of issues that, surprisingly, share some commonalities with those from three decades ago.

Perhaps it's the struggle to connect with a diverse student body, or the need to address social and economic inequalities that persist.

Despite the differences in time and context, the core themes remain relevant, showing that some aspects of the human experience are timeless and continue to impact people in various ways.

This serves as a reminder that we can learn from the past and apply those lessons to the present, regardless of the specific situation.

Anne Fadiman's "The Spirit Catches You and You Fall Down" is a remarkable ethnography that combines multiple narratives.

It tells the story of a Hmong family in Merced, CA, whose infant daughter Lia is stricken with seizures, leading to a complex interaction with the American medical system.

The book also delves into the broader Hmong history, their nomadic origins in China, and their emigration to the US after the Vietnam War.

Fadiman expertly weaves together the Lee family's personal experience with the larger cultural and historical context, highlighting the clash between Hmong beliefs and American medical practices.

The Hmong's distinct religious beliefs, mistrust of US medicines, and difficulties in communication all contribute to the challenges faced by both the family and the medical professionals.

Despite being published in 1998, the book remains relevant today, as immigrants continue to struggle with balancing their culture and assimilation.

The epilogue reflects on the anniversary and reminds us of the progress made in the medical community's acceptance of cultural individualities, but also acknowledges that there is still a long way to go.

This book is a must-read for anyone interested in cultural sensitivity, especially in medical settings. It is dense with facts and information, yet engaging and accessible.

I highly recommend it, and suggest pairing it with other books about immigration or medical challenges, such as Angie Kim's "Miracle Creek" or Alan Brennert's "Moloka’i".

Originally published on my book blog, TheBibliophage.com.