A Review of 'The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures' by Anne Fadiman

Note: This is one of a few reviews leftover from 2015 that I am trying to write and post before I start in on things that I have read in 2016.  Thank you for your patience!

"Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy.  By 1988 she was living at home but was brain dead after a tragic cycle of misunderstand, over-medication, and culture clash: 'What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance.'  The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling.  Sherwin Nuland said of the account, 'There are no villains in Fadiman's tale, just s there are no heroes.  People are presented as she saw them, in their humility and their frailty-- and their nobility."

I had a hard time with this book at times.  I loved learning about Hmong culture and it was interesting to read about how Hmong culture and people are adapting to life away from Laos and Cambodia (because that's largely what this book was about-- the people who emigrated with their families away from the places they called home).  It was incredible to read about how people, especially the children, but even the adults, straddled two cultures at once and managed to keep the culture they brought with them intact, though with some adjustments.

I leave this book thinking everyone is at least a little bit at fault.  I'm disappointed in the hospital for not putting translators at a higher priority, especially when they are fully aware of the demographics of the community that they serve.  They knew that there had recently been a huge influx in the Hmong population.  Instead, what was happening was that nurses aides and technicians at the hospital were being hired, especially if they could speak Hmong, and then they were being used as translators on top of the jobs they were originally hired to do.  I don't know how anyone can be expected to do their hospital tech job and then stop that work and go translate for a family and be expected to do well at all of these things and also, I think, not be properly compensated for doing these two jobs for the hospital.  Both of these jobs are important, but they require a lot of time and different skill sets that aren't necessarily related to each other.  It's not fair to those people.

On the other hand, it also bothers me that the Lee family didn't know even basic words of English that might have helped the doctors diagnose Lia.  If not before the first visit, at least for the subsequent visits before she had an established medical record and a reputation.  Words like "hot," "shake," or "asleep" might have helped the doctors know that she was unconscious and that she had been convulsing (for how long, that's something that the doctors would have to figure out, but at least they'd have some clues).  I think it was especially important to have these words, especially since Lia kept being admitted into the emergency room again and again for the same problems.

The hospital also got too frustrated with the Lee family.  I know that they didn't have a good amount of background knowledge on Hmong culture and beliefs, but you'd think the doctors and nurses would glean that their culture was different than the one the hospital and many of the staff are part of.  Clearly, they can't handle Lia Lee's case in the same way as they can with white patients.  I noticed that towards the end of the book, they had worked themselves into kind of a routine with Lia and as a result, sometimes they became careless.

The family is also quite stubborn.  I became frustrated with some of their interactions with the hospital.  My feeling is that when you come to the hospital, you're recognizing that the situation at hand is bigger than what you can handle and so you go to the doctors who are much more equipped to handle these big situations.  The patient and/or their family ultimately gets to make the choice what happens, but it's the doctors job to use their knowledge to advise the patient and their family in order to help them get well.  It's not the family's job to tell the doctors that they're not doing their job.  That is my biggest point of contention with the Lee family.

As far as language is concerned in this book, I was happy to have my soon to be mother-in-law to talk to about this, as she had read this book for one of her college classes (as I was supposed to have done in my anthropology class, but didn't until a couple years later).  At one of her former churches, they had a decent-sized Koren (Kuh-Ren) population and so the church offered English classes to help these families accomplish basic tasks like grocery shopping and going on a doctor's visit (or other things like that).  I can't remember the question that she asked, but it was something about why they didn't learn some English a little sooner.  Not a question asked in an accusing way, but one that was asked out of curiosity and that was how it was taken.  The answer was basically that they lost their home and they didn't want to lose their culture and native language too.  To me, that's makes sense, but I am having trouble marrying my thoughts on these separate matters together as one coherent thought on the matter.  It seems that there are no winners in this situation and this is something that I need to accept and take into consideration.  I've determined that it's impossible to pick one side, especially when you don't completely agree with how they conducted themselves or how they contradict the "opposing team," so to speak.

I would recommend this book if you don't know a lot about Hmong culture and their history and I would also recommend it if you need a huge issue to chew over for a while.  I don't feel done with this book.  It's given me a lot to think about, absolutely.

I give this book:

Thanks for Reading!

--Jude