The Spirit Catches You: Hmong Culture Clash in Medicine

Introduction to Cultural Conflict in Lia Lee's Case

In The Spirit Catches You and You Fall Down: A Hmong Child, Anne Fadiman tells the story of the effects of culture clash in medical care through the experiences of Lia Lee and her medical treatment. The Hmong are an old and resilient culture from Laos who have fiercely defended their traditions and way of life — 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 from which Lia Lee suffered.

The Hmong, a minority tribe of Laos, hold extensive spiritual beliefs regarding physical health and the causes of illness. They also observe specific customs for opening conversation that signal the speaker's peaceful intentions. Lia's doctors, unaware of these cultural complexities, approached her situation logically and clinically — an approach that was completely alien to her Hmong relatives. The family believed she should be treated with animal sacrifice and prayer, both practiced in highly ritualized ways. The medical staff did not understand the vast gulf of belief separating them from the Hmong family they were trying to help.

Hmong History, Persecution, and Involuntary Migration

The Lee family had good reason to trust their own beliefs over those of outside authorities. 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 war and subjected to starvation. The Hmong fled to Thailand, where they were recaptured and forced back into Laos, enduring conditions resembling those of a concentration camp. After three years of persecution, they fled again — evading both Laotian 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 States and settled in Merced, California. They were illiterate but proud, and they did not intend to assimilate. In fact, they had come to the United States precisely to resist the forced assimilation they had faced in Southeast Asia.

Cultural Identity and Resistance to Assimilation

"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 classify them as involuntary migrants (p. 183). However, they were not intimidated by the many unfamiliar things they encountered in the United States, because they understood themselves as Hmong, not Americans. Fadiman reports that the Hmong learned American ways only when doing so supported their desire to stay connected with other Hmong. They learned to drive and to use the telephone because these skills helped them maintain ties with fellow Hmong — but they had no interest in learning English (p. 189).

Conclusion: Bridging Cultural Differences in a Diverse Society

Fadiman's book puts real faces on the difficulties the United States faces as it becomes the new home to people whose backgrounds, beliefs, and cultures are radically different from the European roots other immigrants either possessed or at least had some knowledge about. The Hmong in the book are truly fish out of water, and for the Lees, there was no one around to help them bridge the differences.

The case of Lia Lee stands as a powerful reminder that cultural competence in healthcare is not a luxury but a necessity. When medical systems fail to account for the deeply held beliefs and experiences of the patients they serve, the consequences can be devastating — not through malice, but through the quiet assumption that one culture's logic is universal.