I've never quite read a book like this.

Essentially, The Spirit Catches You and You Fall Down is about the medical struggles of a child with epilepsy. However, through this narrative, Anne Fadiman delves into a plethora of complex topics. She discusses cultural challenges in medicine (and in general), immigration, Hmong history and culture, and trust in an incredibly thorough and fascinating way.

I find that it's easy (for me, at least) to fall into two camps when talking about different cultures and medicine. Either I think that medicine is a relativist thing and each culture has its own valid way of treating ailments. After all, who really knows how this world even works? Or I believe that Western medicine is simply better for everyone and those who think an animal sacrifice can heal a child shouldn't be given children.

Now, in this book, Fadiman tackles both of these mindsets and manages to find the middle ground. She doesn't lean too far into either side. There's something fantastically moderate and intelligent about the way she approaches this topic.

Moreover, through this book, it's so easy to empathize with everyone. I was skeptical at first, but around the middle of the book, I found myself understanding the fears of Lea's parents. Their fears became so vivid and real for me. Fadiman highlights how in so many ways, the medical failures were no one's fault and yet, they could have been avoided. Finding this balance is truly an impressive achievement.

Reading this book felt like an applied form of 21 Lessons for the 21st Century. Harari discusses four topics related to immigration, one of which is whether the state owes something to immigrants. It's clear that the Hmong people feel (and rightfully so, I'd say) that the states owe them something for their help in the war. Yet, looking at the way they were treated, it's evident that this mindset isn't shared by the states.

In many ways, this is even more interesting because both the Hmong and the Americans would prefer the Hmong not to be on welfare. But precisely because of the cultural differences, everyone ends up unhappy. It could have been a win-win situation but instead became a lose-lose situation. This is different from what I usually think about when considering cultural differences.

There's so much depth and substance in this book. However, I haven't finished my Econ homework, so this might be a good place to stop. Although it was written in 1997, it remains remarkably relevant for so many contemporary issues. I'm convinced that several of the ideas here will stay with me for a long time.

What I'm Taking With Me

- I would absolutely love to see Fadiman research every controversial topic ever.

- Am I still a bit bitter about that one paragraph comparing the Hmong people to Jews and claiming they're more impressive because they're not bound by a religion together? Just a little.

- Cultural brokers are crucial! Combining medical treatments with religious ones, ensuring everyone understands each other, and taking the time to ask people how they perceive their illness!

I rarely read nonfiction. However, after a one-way run, I discovered The Spirit Catches You and You Fall Down in a Little Free Library. I then picked it up and went to a coffee shop to read it while sipping a post-run latte (pre-COVID-19, alas). I began reading in line and only paused to fit in book club reads.

The Spirit Catches You and You Fall Down narrates the tragic tale of Lia Lee, a young Hmong child residing in Merced, California. Her family fled Laos via Thailand and came to the U.S. as refugees. As a child, Lia develops epilepsy, which her parents regard as an auspicious sign indicating that Lia might possess the coveted ability to communicate with spirits. They take Lia for treatment at the hospital and clinic in Merced as required, but they are distrustful of the doctors' aggressive, Western approach to treating Lia. The doctors, in turn, cannot fathom why Lia's parents do not administer her prescribed medications or take the steps they deem necessary to treat Lia's condition. Lia's parents, for their part, enlist shamans to assist in bringing back Lia's soul and treat her with herbal remedies and poultices both in the hospital and at home. The true tragedy of the book lies in the complete failure of both sides to understand each other and address Lia's medical needs before they spiral out of control.

The book alternates between Lia's story and the broader narrative of the Hmong people, particularly Hmong refugees in the United States, and the increasing interest in cross-cultural medical care. Published in the late 1990s, the book was a resounding success, both in terms of sales and in changing people's minds. It is now taught at medical schools across the country, and it seems that the stubborn approaches of both Lia's doctors and her parents have been mitigated by greater understanding in the medical community regarding the facilitation of cultural understanding between physicians and patients.

I was especially intrigued by this book because I traveled to Laos a couple of years ago and had the opportunity to visit a Hmong village in the mountains above Luang Prabang. I learned a little about their culture, which is so vastly different from my own. I truly relished learning more about the Hmong people through this book, and if I were to visit Laos again in the future, I would bring with me a deeper understanding of the Hmong people and the political backstory that led to the ongoing divide in Laos today.

Temporary DNF after 6 chapters.

I do have a strong desire to finish this book. However, currently, it doesn't seem to be an opportune moment in my life for me to focus intently on non-fiction.

The reason is that this book is now due to be returned to the library. Under such circumstances, I have come to the conclusion that it's time to put it aside for the present and make another attempt at a later stage.

Although I'm disappointed that I couldn't complete it this time, I firmly believe that there will be a more suitable time in the future when I can fully engage with this book and gain all the knowledge and insights it has to offer.

I look forward to that day when I can pick up this book again and continue my reading journey.

The blaring bias in this book was truly exasperating.

It was blatantly evident that the author, despite her training as an anthropologist, was more focused on crafting a story to prove a point.

She selectively highlighted elements that supported her thesis while conveniently ignoring those that didn't.

This is perfectly exemplified in her description of the ER doctors attempting to save the life of the main character, the child.

She claimed to be horrified that the ER doctors didn't exit the emergency room, seek out a translator, and explain the situation to the parents who were anxiously watching.

However, has any ER doctor ever done this for anyone? The answer is a resounding no, and they shouldn't.

Their primary priority is to do everything within their power to preserve the patient's life.

In no circumstances, regardless of the patient's or parents' ethnicity or their English proficiency, should a doctor abandon an emergency situation to converse with the parents.

Yet, the author makes a big deal out of how culturally insensitive it was for the doctors not to leave the ER, in the middle of a life-saving procedure, to talk to the distraught parents.

The author has taken a professional doing their job and twisted it into what appears to be blatant cultural insensitivity.

There were numerous instances where this author made ill-informed attempts to convince the reader that the medical community is at best culturally insensitive or at worst racist.

As a result, I simply couldn't bring myself to finish the book.

Ironically, as an anthropologist, it is your responsibility to present data in an unbiased manner, which this book fails to do completely.

In Hmong culture, the reverence for children is truly remarkable. It is a beautiful aspect of their traditions.

This particular little girl held a special place in her parents' hearts as their favorite. What's more, they firmly believed that her epilepsy was not a burden but a special gift. They thought it made her more attuned to the spirit world. Interestingly, many of the spirit healers within Hmong society also have epilepsy.

On a broader scale, this is a story that highlights the clash between western and eastern cultures. It showcases a significant communication lapse that had extremely profound and hurtful consequences for the parents of this little girl. The differences in beliefs, values, and ways of understanding medical conditions led to a situation where the parents' perspectives were not fully understood or respected in the western context. This lack of communication and cultural understanding ultimately caused great pain and distress for them.

It serves as a reminder of the importance of cultural sensitivity and effective communication when dealing with diverse populations.

The first, spontaneous reaction with regard to the stranger is to imagine him as inferior, as he is different from us.

This is especially evident in the case of Lia Lee. Her parents immigrated to the US in the early 1980s from Laos. They belonged to the Hmong culture, a people who inhabited mountaintops and desired only to be left alone. During the war, they sided with the Americans. Their men joined the military, and some even became pilots. When the war was lost, they had no choice but to leave their country or face death. They were promised a place in the US, and eventually, thousands immigrated to the US and other countries.

The cultures were so extremely different, as suggested by the title, "A Hmong child, Her American Doctors and a collision of cultures." Lia's story is about epilepsy and the wrong treatment. The author conducted years of research on the culture, the people, their history, and the medical treatment. This book should be a must-read for all medical personnel as it provides valuable insights into the importance of understanding different cultures in providing appropriate medical care.

It highlights the need for medical professionals to be more sensitive and aware of the cultural backgrounds of their patients to avoid misunderstandings and misdiagnoses. By reading this book, medical personnel can gain a better understanding of how cultural differences can impact the patient-doctor relationship and the treatment process.

Overall, Lia Lee's story serves as a powerful reminder of the importance of cultural competence in the medical field.

I opened this book with the anticipation of delving into the world of a specific people, the Hmong, within a particular time and place, contemporary America. However, Anne Fadiman has achieved the remarkable feat of a great novelist, using the particular to illuminate the general. The story of Lia Lee, the epileptic daughter of Hmong refugees, holds profound and far-reaching implications.

The most evident question this book poses is: How should Western medicine interact with members of vastly different cultures? This is both a practical and a moral query. As Fadiman vividly illustrates, cultural misunderstanding was the prime cause of Lia's medical tragedy. The doctors failed to understand the beliefs, values, and thought processes of the Lee family, and the parents had a very different perception of the doctors' actions and Lia's illness. This led to a significant breakdown in communication that might have been preventable had the medical staff implemented better strategies for bridging cultural gaps.

This narrative also casts an interesting light on the current conflict between public health officials and anti-vaxxers. A major source of tension was the parents' reluctance to administer anti-seizure medication. (They didn't trust its efficacy and likely struggled to follow the regimen due to illiteracy.) At one point, the doctors even resorted to calling child protective services to place Lia in foster care because of the parents' non-compliance with medical orders. As Fadiman makes clear, both the doctors and the parents were acting in accordance with what they believed to be right, based on their knowledge and beliefs. Doubtless, the same dynamic is playing out in the current pandemic regarding the vaccine.

The question then becomes: How can respect for individual autonomy, empathy for different beliefs, and the need to protect health be balanced when these values clash? There is a strong argument to be made that health takes precedence over all other values, as without life, one can have neither beliefs nor autonomy. However, as Lia's story shows (and I'm trying not to give away too much), applying excessive force can undermine the very thing we are attempting to safeguard. In other words, health is also promoted by autonomy and empathy, sometimes to the same extent as by medicine. I highly doubt that there is a one-size-fits-all answer to this conundrum.

The story of the Hmong also provides an enlightening perspective on the recent Afghanistan withdrawal. This particular passage is rather eerie to read now:

Several times the planes were so overloaded they could not take off, and dozens of people standing near the door had to be pushed out onto the airstrip. … After the last American transport plane disappeared, more than 10,000 Hmong were left on the airfield, fully expecting more aircraft to return. When it became apparent that there would be no more planes, a collective wail rose from the crowd and echoed against the mountains.

For those unaware, the Hmong were (illegally) recruited by the CIA to fight a secret (and illegal) war in Laos. After bombing half the country into ruins, the U.S. ultimately turned and fled, leaving thousands of people who had fought for us in hostile territory, forcing them to flee for their lives. Many, like the Lees, made it to Thailand and eventually to the United States as refugees. Ironically, but unsurprisingly, these refugees (many of whom were veterans) faced racism and discrimination in their new home, a backlash that ultimately made it more difficult for refugees to enter. Does any of this sound familiar?

To keep this review concise, the story of Lia Lee, although presented with a light touch, leaves a lasting impression on the reader's mind. Anytime we encounter a radically different worldview, such as that of the Hmong, we are confronted with the disconcerting question: How much can our own culture or version of reality be trusted? But this book goes beyond that unanswerable question to explore many others that can be addressed: How should we treat refugees? How can we bridge cultural divides? How can we make medicine more humane? It is truly an enlightening read.

As the author mentions in her epilogue, this is a book written in the 1990s about the 1980s.

Undoubtedly, a white woman may not be able to fully comprehend or express the extensive Hmong culture. Perhaps a Hmong author could have presented it in a more accurate and detailed manner. Nevertheless, I truly adored this book.

I would most definitely place it on my shelf of remarkable, well-written, and captivating non-fiction, which is likely my favorite genre. Before delving into this book, I was completely ignorant about the history of Laos or the Hmong people.

This book provided me with the wonderful feeling that great books often do, that the world is vast and filled with an abundance of things to discover and know. I now have a list of topics that I渴望 to read more about, which were brought to my attention by this book.

Without a doubt, it is one of the best books I have read this year.

I have a particular appreciation for books that have the ability to open my eyes and show me the world in a new light. It doesn't matter if they are mysteries, literary fiction, vampire tales, or nonfiction. When I come across a book as thought-provoking and engaging as this one, I feel as if I've discovered a precious gem.

Anne Fadiman's book, The Spirit Catches You and You Fall Down: A Hmong child, Her American Doctors, and the Collision of Two Cultures, does precisely that. She seems to have a better understanding of the Hmong family than Lia Lee's doctors, but Fadiman makes a genuine effort to understand both sides.

Lia Lee began having seizures at just three months old. Due to a possible misdiagnosis, she had a severe seizure that led to a coma. Although she was expected to die, she lived for an additional 26 years, loved and adored by her parents and family - and also by Fadiman. Lia's life, especially in her early years, was marked by significant conflict between her parents and the medical system. Some of the challenges they faced include:

* Who should be grateful to whom? The Hmong for the welfare they received in the US? Or the US for the sacrifices the Hmong made in fighting?

* How do we measure the "success" of a refugee group? By their use of welfare or by social indices like crime, child abuse, illegitimacy, and divorce, which were all very low among the Hmong?

* What causes illness? Is it a biological force gone awry, as Lia's physicians believed, or soul loss, as the Hmong thought?

* Surgeons believed that removing cancer would keep a person alive, but the Hmong believed it would put their soul at risk and their physical integrity in the next life. Who among the Hmong would take that risk?

* US doctors thought they were helping Lia, while the Lees believed their treatments were killing her.

* Like her doctors, Lia's parents wanted her to be healthy, but they also said, "we are not sure we want her to stop shaking forever because it makes her noble in our culture, and when she grows up she might become a shaman."

So, how should we handle these differences? When we view difference as a threat, especially to our own worldview, we tend to reject it and see the other person or culture as wrong or inferior. But if we do that, how can we effectively work with someone who is different from us? Fadiman argues that we should take a step back, recognize other perspectives, and listen. This attitude of cultural humility can be difficult to adopt, especially if we are used to thinking in terms of right and wrong, but it can be extremely useful.

And perhaps it could have saved Lia Lee.

Anne Fadiman delves into numerous challenging topics as she portrays a Hmong couple's pursuit to restore their child's soul. Growing up in a family of doctors and nurses, I regarded myself as culturally sensitive and firmly believed that the world's top doctors, whether foreign or local, were on American soil. However, upon reading Fadiman's account, which includes actual excerpts from the patient's charts, I had to closely examine my assumptions. During the process of reading this book, I have redefined my concept of what makes a good doctor.

Fadiman dedicated hundreds of hours to interviewing doctors, social workers, and members of the Hmong community - anyone connected to Lia Lee's medical nightmare. She meticulously studied years of medical records, striving to make sense of the events that led a lively, affectionate toddler to gradually decline into a vegetative state. What she discovered was that the doctors' orders, prescribed medications, hospital care, and so on were all founded on a set of Western assumptions that failed to consider the family's (and child's) best interests. No effort was made to understand how the family perceived the disease or what they were doing on their own to address the situation. What the doctors and other professionals involved in Lia's case required was not just a translator but a "cultural broker" who could have intervened and potentially prevented Lia's brain from further deterioration.

Fadiman's book is a tough read, not due to specialized vocabulary or lofty philosophical ideas, but because at a certain point, the reader realizes that the barriers faced by those involved were more cultural than linguistic. In a very real sense, the Lees inhabited a different world from the doctors, and vice versa. Each side assumed their way was the best, and neither made a sincere effort to understand the other's motivations, let alone their reasoning. In the end, there was no easy solution to their困境, but greater mutual respect and understanding of the cultural differences would have benefited everyone involved.

If there is a moral to Fadiman's work, it might be this: The best doctors are not those who know the most but those who admit what they don't know and attempt to understand the whole picture. Good doctors may treat the disease, but the best doctors treat the individual.

Wow. This is probably the first non-fiction book that I've read in like probably.....5 years? Maybe more?

I initially started it because I was like "well I'm gonna be a doctor now, might as well get in some cross-cultural education so I can sit on my high horse!!!", but now that I'm done I feel like I have more questions and considerations rather than like....concrete lessons about how to approach intercultural care LOL.

I suppose that's the point of it and frankly, that's just how I like it. Really, this book isn't about ME anyway, but about the little girl and her family. I loved how the author took her time to spin out Lia's whole story, rather than shoving down my throat one side or the other.

I felt empathy towards the parents, but then I would equally be pulled towards frustration that their culture would bring to their healthcare team. It's like we couldn't just settle on one easy answer of who was right and who was wrong. And you know what, I respect that.

Something I didn't really like were the long chapters about the sociopolitical history of the Hmong. Just ngl it lost me a little. That said, I can see the necessity of involving those chapters, because someone's culture isn't just the customs and beliefs you see, but the lifetimes of history that shape them.

Overall, I think it was a very sensitive exploration of a topic that I find VERY personally relevant hahah. The only thing is like....what do I do with all these THOUGHTS now HAHAH, I feel like I STILL don't know what to do in an actual instant of cultural miscommunication. But I suppose that wasn't really Anne Fadiman's place to say anyway, that's gonna be up to me.

I guess this all commences with President Eisenhower, who placed great emphasis on the Domino Theory. As a result, he tasked the CIA with identifying individuals residing near China who might be willing to combat the communists on behalf of the USA. Of course, the USA couldn't be seen as directly engaging in the fight, as that would violate certain principles. One such group was the Hmong people in central Laos. I, for one, had never heard of them before.

It wasn't that these Hmong despised the communists. Instead, they believed that the communists would prevent them from farming in their traditional Hmong way. Thus, depending on one's perspective, they either became CIA pawns or brave American allies. Then, in 1975, when the communists took over Laos, the Hmong found themselves on the losing side of the equation, and they began to flee in droves, so to speak.

To cut a long story short, a significant number of them gathered in Merced, California. No, I had never heard of Merced either, and surely the Mercedians had never heard of the Hmong before 1978, but then they did.

Now, these were not people emigrating to America with the intention of becoming Americans, waving the flag, singing the Star Spangled Banner, and devouring burgers. They wanted to remain as Hmong as possible. Consequently, most of them refused to learn any English. Not surprisingly, they were mostly reliant on welfare and became known as the "least successful refugees."

It was astonishing to examine the bar graphs comparing the Hmong with the Vietnamese, the Cambodians, and the Lao, and see how the Hmong fared: most depressed, most psychosocially dysfunctional, most likely to require mental health treatment, least educated, least literate, and with the smallest percentage in the labor force.

Also not surprisingly, there was an insurmountable chasm of misunderstanding between the Californians and the Hmong. For instance, a health worker visited a Hmong family to check on their daughter - this family is the subject of the book. The health worker told the interpreter, "It is beneficial if mama can take her pulse daily." The interpreter replied, "She says they don't know how to measure the pulse." The health worker then said, "Well, you simply place your finger here, and use your watch to count for a minute." Anne Fadiman remarks:

Foua (the mother) didn't possess a watch, nor did she know what a minute was.

Here's a more disturbing example:

A Hmong child in San Diego was born with a harelip. Her doctors sought the parents' permission to surgically repair it. They cited the benefits of the operation and the social ostracism the child would otherwise face. Instead, the parents fled the hospital with their baby. Several years earlier, while the family was escaping from Laos to Thailand, the father had killed a bird with a stone, but not cleanly, and the bird had suffered. The spirit of that bird caused the harelip. Refusing to accept the punishment would be a serious insult.

DON’T TOUCH A NEWBORN MOUSE

Some additional Hmong beliefs about illness:

Falling ill can be attributed to various factors, such as consuming the wrong food, failing to ejaculate completely during sexual intercourse, neglecting to make the appropriate offerings to ancestors, touching a newborn mouse, or urinating on a rock that resembles a tiger. However, a significant portion of illness is believed to be caused by dabs. A dab is an evil spirit that can suck your blood and cause all manner of mischief. So, your illness might be the result of encountering a dab that inhabits a tree or a stream, or if you catch a glimpse of a dwarf female dab eating earthworms, or simply because a dab is attracted to your soul and lures it away from you. That would make you extremely ill.

Hmong healthcare primarily revolved around sacrificing a pig or, in more severe cases, a cow in the family home. A shaman would be present to conduct the proper ceremony. Then, some herbal remedies would be administered, and everything would be expected to be fine.

The American medical profession wasn't particularly interested in all of this, and Anne Fadiman isn't suggesting that they should have been either. However, there was such a profound lack of understanding on both sides that when this family's youngest daughter was born with severe epilepsy, a series of disasters ensued, ultimately leading to the girl developing what the doctors termed hypoxic ischemic encephalopathy (static), or what you might call a persistent vegetative state. Alive, yet in a sense, dead.

Lia, this girl, was in and out of hospitals countless times, and sometimes in intensive care, yet it all went awry. A doctor casually calculated the total cost to the state of Lia's care:

$250,000

WELL, WHAT IS THE TRUTH?

A well-meaning health worker:

I’m not overly interested in what is commonly referred to as the truth. In my opinion, consensual reality is superior to the facts.

Anne Fadiman never asserts that this entire elaborate spirit world belief system is nonsensical. Never. But to a Western reader, that idea lingers throughout the entire book. She does state that it would be extremely difficult for Western medical practitioners to conceive that "our view of reality is merely a perspective, not reality itself." Because empirical, Cartesian, science-based, clinically-trialled, peer-reviewed Western medicine is indeed regarded as true, not just one of several possible truths.

The Hmong were an isolated ethnic group that didn't intermarry with the Lao, and one can imagine that their beliefs have been continuously passed down for centuries. In today's world, we are witnessing the emergence of alternate-reality belief systems across social media, to the extent that there is now as great a divide between a Stop the Steal conspiracy theorist Trump supporter and a normal person as there was between the Hmong and their Californian doctors.

This is a clearly written,始终引人入胜, assumption-challenging, and excellent read. It sat on my shelf for 6 and a half years before I finally picked it up.

Highly recommended.