I first read this book approximately three years ago and have recently re-read it. I am a social worker and educator, and I have been distributing copies of this book to everyone I know. This is because it is relevant to anyone who has interactions with people of different cultures.

It reads like a novel and is a real page-turner. Additionally, it is filled with information and written in a literary and beautiful style.

The book centers on the clash between Hmong culture and traditional western medicine. The story is about a little girl with a seizure disorder whose family turns to California doctors for help. The Hmong have a complex and almost mythological belief system based on centuries of narrative. Their views on health and healing are intricate, and many of these beliefs are not easily translatable into the English language. There may be no English word that accurately captures the Hmong concept.

Ms. Fadiman examines, in a meticulous and compassionate way, how the family's belief system and their desire to assist their daughter lead to a terrible conflict with the medical doctors in the U.S. She shows empathy for both the Hmong family and the physicians who are attempting to treat a girl with a life-threatening illness. The doctors believe the family is non-compliant, while the family feels they must adhere to their spiritual belief system and treat their daughter in a manner very different from what is recommended by her physicians.

I cannot fathom anyone not loving this book or not being able to relate to an experience where they felt their belief system was not understood by others for any reason. I highly recommend it for a wonderful reading experience and to enhance one's understanding of the difficulty of truly understanding another's cultural beliefs.

4.5 Stars.

"We do not see the world as it is. We see it as we are." This profound statement from the Talmud, Immanuel Kant, and/or Shirley MacLaine (p. 300) makes us think deeply. This book excellently documents the collision of two cultures regarding the medical care of an infant with epilepsy. There are language barriers and belief barriers.

My daughter first recommended this book, but I never got around to reading it. Then a patron mentioned it, and I commented that my daughter said to read it. The patron told me I had to read it, and when I saw her again a few weeks later, she asked if I had read it yet. So, I finally read it!

The author found eight questions devised by Dr. Arthur Kleinman (p. 260), who has extensive experience dealing with people from different cultures. I think these questions are worth remembering. Truly, we view the world and how it works very differently.

What do you call the problem?

What do you think has caused the problem?

Why do you think it started when it did?

What do you think the sickness does? How does it work?

How severe is the sickness?

What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?

What are the chief problems the sickness has caused?

What do you fear most about the sickness?

The story of Lia Lee is a complex and tragic one that highlights the clash of cultures and the importance of understanding and empathy. When Lia was just three months old, she had her first epileptic seizure. Her Hmong parents, Nao Kao and Foua, took her to the hospital, but the language barrier and cultural differences led to a series of problems. The doctors misdiagnosed Lia at first, and when they finally determined her condition, the Lees did not follow the treatment plan due to their spiritual beliefs. This led to a breakdown in the relationship between the Lees and the doctors, and ultimately, to a medical and emotional catastrophe for Lia and her family.

Anne Fadiman's book, "The Spirit Catches You and You Fall Down," tells this story in a beautiful and engaging way. She interweaves the narrative of Lia's care with sections on the history of the Hmong and their journey to America. Fadiman explores the Hmong's animist beliefs and the complex system of rituals and traditions that govern their lives. She also delves into the difficult topics of refugee crises, assimilation, and end-of-life decisions.

The book has generated a lot of controversy, with some people accusing the Hmong of being irresponsible and ungrateful. However, Fadiman handles these topics with grace and nuance, showing that there are no easy answers. She points out that the doctors also bear some responsibility for not taking the time to understand the Lees and their culture.

Overall, "The Spirit Catches You and You Fall Down" is a powerful and thought-provoking book that challenges readers to think about the importance of cultural competence and empathy in healthcare. It is a must-read for anyone interested in medicine, anthropology, or social justice.

It is also a reminder that we are all human beings, with our own beliefs and values, and that we should strive to understand and respect each other's differences.

First non-fiction and five star read of 2025!

I read this for my social work class— Human Behavior in the Social Environment. I have to write a paper as well.

This book was truly phenomenal, in my humble opinion. It was written in the 1990s, and yes, there is some language used that might seem a bit questionable nowadays as social norms have evolved. However, back then it was socially acceptable. What really stood out to me was how comprehensively it covered so many aspects of social work. I can clearly see why we were instructed to read this book.

It presents such a sad story of a clash between cultures, where in reality, everyone was truly a victim in their own unique way. After reading this book, I feel that I have emerged more respectful. I now have a much better grasp and understanding of the term “cultural competence/cultural humility”. It's no longer just a term to me, but something that I truly understand as a practice. Truth be told, I simply could not put this book down. It held my attention from start to finish and has left a lasting impact on my perspective.

I'm looking forward to delving deeper into this topic as I write my paper for the class. I'm sure there's still so much more to discover and learn from this remarkable book.

Such a unique and human perspective on a very unique and human culture that I knew nothing about. It is truly fascinating to learn about the Hmong culture in this way. The survival of the Hmong culture despite thousands of years of oppression from all sides is not just a matter of luck. It is due solely to the incredibly remarkable qualities and facets of the culture that have remained consistent across thousands of miles and countless generations.

The Hmong people have managed to preserve their traditions, language, and way of life through the ages. Their strong sense of community, family values, and connection to nature are some of the aspects that have contributed to their survival. Despite facing numerous challenges and hardships, they have continued to uphold their cultural identity and pass it on to future generations.

This article has opened my eyes to the rich and diverse world of the Hmong culture. It has made me realize the importance of respecting and celebrating different cultures. I look forward to learning more about the Hmong people and their unique way of life in the future.

This is one of the best books I've ever read.

I would guess that it could be classified as part of the medical anthropology genre. However, it is so captivating that it completely transcends that rather dry and nerdy-sounding label.

This book was recommended to me during a cultural literacy course, and it truly lived up to the recommendation.

The story revolves around the treatment of an epileptic child from a Hmong immigrant family within the American health system. The central issue is the clash of cultures and the resulting confusion and heartbreak.

The key takeaway from this book is the lesson it teaches about how to conduct our lives once we realize that we have very little understanding of what underpins most other people's frameworks of reality and that we have no right to claim absolute truth.

It makes us want to quickly step back from passing judgment and strive to be a better person. It encourages us to listen more, forgive more, learn more about others, and be more accepting of different realities.

This book is an important challenger of certainties and is highly recommended.

The Spirit Catches You And You Fall Down might seem like a documentary, thanks to Fadiman's journalistic background. However, it is truly an in-depth examination of the western system of medicine and science. We can't metaphorically step back and view the system from the outside. But, comparing it to another (supposedly opposite) system through the experiences of the Hmong refugees can serve as a means to do just that.

The Hmong's assumed non-separation of any aspect of life (especially the physical) contrasts well with the western idea of categorizing and separating the physical, emotional, spiritual, and mental. This categorization reflects a desire for control - labeling and naming are just the initial goals of this desire. In contrast, the Hmong view control very differently. With such significant differences in these fundamental aspects, one wonders if the outcome could have been any different.

Categorization and classification are the foundation of science. It is meant to be 'rational' and evidence-based. Western medicine not only classifies problems into different aspects of the human - physical, mental, emotional, and spiritual - but also tends to over-categorize, with different physicians for different organs or diseases and specialization. On the other hand, according to Fadiman, the Hmong don't even bother to separate these different aspects; they don't even have a concept of 'organs' making up the human body. There is definitely no separation between the physical and the spiritual. Fadiman's observation of the Hmong's obsession with American medicine and the behavior and attitudes of American doctors clearly illustrates this point. This lack of categorization also extends beyond the individual and is reflected in the relatively classless structure of Hmong society: Fadiman points out that the Hmong don't separate themselves by class and live by a more egalitarian standard.

The need to classify and categorize stems from a desire for control. By classifying organisms into different species, genus, or families, we try to exert control over nature. By categorizing people according to gender, class, and race, we try to assign them different roles and duties, further demonstrating society's desire to control individual lives - to maintain 'order'. This desire is even more present in medicine, where we explicitly try to control disease, pain, suffering, and ultimately life (or death). Since the Hmong concepts of separation are almost non-existent, their view is one of 'letting go'. Fadiman shows how holistic their approach is compared to that of the American physicians by demonstrating that even though the Lees cared deeply for Lia (and loved her unconditionally), they still tried to persuade the spirit to release Lia's soul so it would return to her. The American doctors, however, became increasingly invasive, trying in vain to assert more control over the situation by intubating, restraining, and over-prescribing.

Given this difference in the fundamental worldviews of each culture, the question that needs to be answered is: could things have been different? The Lees at one point agreed that they would be willing to use a combination of therapies from both their culture and their recently adopted culture, but would the physicians have complied as well? Given the history of discrimination in this country, would it be wise to return to'separate but equal'? These are just some of the questions that emerge from the book. There may be fundamental differences between two cultures, but could there also be fundamental similarities?

Lia is a Hmong girl with epilepsy in Merced, and her story is truly heartbreaking. This book aims to be an ethnography, presenting two distinct cultural perspectives on her illness: that of her Hmong parents and her American doctors.

Before delving further, it's important to note that this is not a book with a surprise ending. However, if you prefer to approach it with a completely open mind, it might be best to stop here.

I have struggled between giving this book four or five stars. The writing is simply beautiful and compassionate, making you empathize with every single person in the story. Like Lia's doctors, you can't help but feel frustrated with her noncompliant, difficult, and stubborn parents. Yet, considering their history, you can also fully understand her parents' aversion to hospital procedures and their distrust of distant, seemingly superior American doctors. There are no clear heroes or villains in this narrative; it is perfectly balanced. When Lia ultimately becomes brain dead, your heart aches for everyone involved.

There are a couple of reasons I ultimately settled on four stars. Firstly, while the historical background provided in the book is excellent, it sometimes slows down the story. I believe it could have been integrated more seamlessly into an otherwise nearly flawless narrative. Secondly, I found myself questioning the fundamental premise of the book. I'm not entirely convinced that cultural misunderstandings alone led to Lia's eventual "death" (brain death, that is). Lia's epilepsy was, by all accounts, extremely severe and unresponsive to medication. So, I'm not sure that a white, middle-class American girl would have fared any better. This is not to downplay the very real cultural struggle that the book so vividly describes, but some of the author's claims about how cultural misunderstandings "killed" Lia seemed a bit speculative to me.

Overall, though, this is an absolutely beautiful and touching book that should be required reading for everyone in California (and beyond). It offers a profound and thought-provoking look at the intersection of culture, medicine, and human experience.

The Spirit Catches You and You Fall Down by Anne Fadiman is an outstanding piece of work that offers a captivating exploration.

Fadiman masterfully employs the case of a little girl as a starting point to vividly describe the clash between western medicine and traditional Hmong culture. She delves into the historical, cultural, and spiritual aspects that underlie this collision.

As these two distinct cultures strive to coexist for the best treatment outcomes, the reader is presented with an honest and empathetic portrayal of the challenges involved in developing and maintaining such coexistence.

For me, the book's greatest strength lies in how Fadiman seamlessly weaves together the historical, sociological, and anthropological context with Lia's story. It reads almost like a novel, yet is rich in information, powerful in its message, personal in its approach, and highly thought-provoking.

As a westerner, Fadiman shows sympathy towards the doctors, their training, and their perspective. However, she is not afraid to critique them or the Western medical system. This book was highly recommended to me (thank you, Charlene!), and I wholeheartedly pass on the same high recommendation.

Even if learning about the Hmong is not at the top of your intellectual priorities, I discovered that many of the same observations and lessons about medical care are applicable to families who prefer alternative and natural treatments, a growing segment of the population. It is truly a must-read for anyone in the medical field, and a great read for anyone, regardless of their background. (10/10.)

At the time this book was written, perhaps no immigrant community differed more from American culture than the Hmong.

This vast difference was most显著 in their views on health and illness. The book centers on the case of an infant with epilepsy. While her family believes it's caused by issues with her "soul", the medical community sees it as a "physical" defect.

Obviously, this leads to many conflicts, worsened by the fact that the family doesn't speak English, translators are hard to find, and there's no way to translate some English/medical terms into Hmong.

Through the book, various interesting questions are raised, such as immigration issues and how society decides who is "deserving" to come to this country.

Also, international politics come into play as the Hmong fought for the US against communism in Southeast Asia and were "promised" support if the country fell to the communists.

There are also important questions about who gets to decide what treatment a child can have and whether parents' non-compliance due to believing the medications are making the child worse constitutes child abuse.

I'm not a cultural relativist, and sometimes the author seems to favor this stance, which bothered me.

All cultures have aspects that aren't "good". But I also believe some cultures are better than others, especially when dealing with certain problems.

For example, a culture that condones slavery is worse than one that doesn't. I tend to favor a realpolitik approach.

While it might have been a bad thing to make these people fight "for us", it's clear they were also fighting for themselves as there was no love for the Hmong among the communists.

So, aside from making the stupid mistake of making certain "promises", it's not clear to me how America felt obligated to bring these people here as refugees.

And if you bring them in, there has to be an understanding of the culture and the acceptance that at least for the first arrivals and the more immediate generations, there might be a very difficult time coexisting at first and certain allowances have to be made for their long-held beliefs.

Reading this book was quite interesting. Not only because the traditional Hmong worldview is fascinating, in many cases superior to ours, and in others quite maladaptive when in America, but also because this contrast allowed me to see more clearly the culture of American Medicine.

While it's changing, it's so focused on the physical aspect of illness that the role of disease on the psyche of the individual, the family, and even the community gets very little attention.

Even Psychiatry has become a specialty of deciding what drugs to use or what physical intervention to try. Gone are the days when psychiatrists actually spent time talking to someone and getting to know them as individuals and as members of a community.

This book will definitely make you think. Even though things have changed a lot since its publication, as the Hmong born and raised in the States are now adults, its lessons and questions are still relevant, especially in a nation of immigrants like ours.

While the attitudes of both the Hmong and the Americans described in the book can be frustrating and sometimes infuriating, I believe you'll understand both sides by the end of the book.

Paperback - 2.5 ⭐️s rounding up.

I read this book for the book club in the month of April. It was an interesting experience as I got to read something that I don't usually pick up. However, unfortunately, my interest in medical things is not very high.

The story itself was quite engaging and it effectively brought up some significant issues within our American medical system. This aspect of the book was thought-provoking and made me think about the various challenges and problems that exist.

Nevertheless, the Hmong history chapters were where the book lost me. I'm sure that this part of the story is interesting to some people, but for me, it felt like reading a history textbook. It just didn't hold my attention in the same way that the other parts of the book did.

Despite my lack of interest in the Hmong history sections, I still look forward to our book club discussions. I'm sure that the other members will have different perspectives and insights, and I'm eager to learn from them and have a lively discussion about the book.

Overall, while this book wasn't a perfect fit for me, it did have some redeeming qualities, and I'm glad that I read it as part of the book club.

As I delved into this book, it became immediately clear to me that it would have a profound impact on how I approach my work and my time in Southeast Asia from now on.

It's a pity that I didn't come across it during my numerous socio-legal studies, anthropology, and migration and health courses. However, I'm extremely glad that I've discovered it now.

Every social/case worker and patient/refugee advocate should definitely read this remarkable piece and carefully internalize its valuable lessons.

Fadiman's work is filled with an abundance of humility, patience, empathy, and humanity. There is so much to learn about the Hmong community, about the concept of care, and about the arduous struggles of migration.

This book explores intercultural communication, assimilation, the ethics of care, and the challenges faced by migrants and refugees in the realm of health in a truly unique and eye-opening way that I have seldom witnessed before.

After reading this, I find myself with an even greater sense of gratitude towards my colleagues, interpreters, and Hmong clients.