Spirit Catches You and You

Spirit Catches You and You Fall Down: A Hmong Child, Anne Fadiman tells the story of the effects of culture clash in medical care as she tells the story of Lia Lee and her medical treatment. The Hmong are an old and strong culture from Laos. They have fiercely defended their culture and their ways whether invaded by another country or living among people of a different culture. When they began moving to the United States, they brought their passionately strong feelings about their culture and beliefs with them. Among the Hmong, "the spirit catches you and you fall down" is how they explain epilepsy, the condition Lia Lee has.

The Hmong, a minority tribe of Laos, have extensive spiritual beliefs regarding physical health and the causes of illness. They also have specific ways of opening conversation that demonstrate that the speaker does not intend them any harm. Lia's doctors, unaware of these cultural complications, approached her situation logically and clinically, an approach that was completely alien to her Hmong relatives. The family believes she should be treated with animal sacrifice and prayer, both practiced in highly ritualized ways. The medical staff does not understand the gulf of beliefs between them and the Hmong family they are working with.

The Lee family has good reason to trust their beliefs. They fled Laos after the Chinese toppled their 600-year monarchy, and then attempted to "cleanse" the country of the minority Hmong. They were used as cannon fodder in the war and starved. The Hmong fled to Thailand, where they were recaptured and forced back to Laos and an almost concentration-camp like life. After three years of persecution, they fled again, avoiding both Lauotian and Vietnamese soldiers, back into Thailand.

After a year in a Thai refugee camp, where over 80% of the Hmong were malnourished or otherwise ill, the Lees emigrated to the United dates. They settled in Merced Calfornia. They were illiterate but proud, and did not intend to assimilate. In fact, they had come to the United States to resist forced assimilation in Southeast Asia.

The Hmong came to the United States for the same reason they had left China in the nineteenth century: because they were trying to resist assimilation." (p. 183) Sociologists would call them "Involuntary migrants (p. 183). However, they were not intimidated by the many strange things they saw in the United States, because they were Hmong, not Americans. Fadiman reports that the Hmong learned American ways only when they supported their desire to stay in touch with other Hmong. So they learned to drive and to use the phone, because that supported their keeping ties with fellow Hmong. However, they had no interest in learning English (p. 189)..

Unfortunately it was quite difficult for the Lee family to maintain their Hmong beliefs about family. In what sociologists call "role loss," the men in the Hmong community had great difficulty finding work, the mothers had difficulty functioning as they thought mothers should, and as the children learned English in school, they suddenly became more important than they would be in traditional Hmong life, because they could translate (p. 208). These proud people had difficulty understanding what was and was not acceptable behavior; in Philadelphia, Hmong used crossbows to hunt pigeons.

They were confused to find that they were not welcomed with open arms by the Americans. The CIA had made promises to them. Those promises were not fulfilled in Laos, so they expected them to be fulfilled in the United States. They did not view welfare as a gift but as payment they earned in Laos, and could not comprehend why some Americans were angry at them for accepting it.

Within this clash of cultures, the Lee family did not know how to cope with the medical system in place to help Lia and her epilepsy. When they refused to give her the medications, Lia was removed from the home and placed in foster care. When the foster care parents gave her the prescribed medication, her condition worsened in several important ways. The foster parents believe that Lia's parents realized that, and that this is why they did not give her the medication, but did not have the cultural and language skills to communicate this to the medical staff.

Fadiman points out through example after example that the medical staff looked at Lia only as her illness, not as an individual, and certainly not as an individual part of a strongly developed culture that was markedly different than the hospital culture within which the doctors worked. Through a translator, a doctor wants to just order a woman to take her tuberculosis medication even though she is pregnant. The translator coaches the doctor that the conversation must open with the doctor expressing good wishes for the man and his family. So the doctor says she "wishes that his children would never be sick, that their rice bowls would never be empty, that his family would always stay together, and that his people would never be in another war." (p. 264). With this opening, the Hmong man relaxed and listened to what the doctor had to say, had his very serious concerns addressed, and then announced that his wife would take the medicine.

By comparison, when Lia's father was told she was probably going to die, the staff asked him to sign an organ donation form. He believed they intended to let her die to take her organs, and tried to flee the hospital with her.

Fadiman wrote out what the Lees would likely have said had they been asked, what kind of treatment she should receive. They would likely have suggested... medicine for a week but no longer... after she is well she should not take the medicine any longer. You should not treat her by taking her blood or the fluid from her backbone... we hope Lia will be healthy, but 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." (p. 260). It is hard to imagine a system of beliefs more at odds with how the medical staff thought Lia's epilepsy should be managed.