"The Spirit Catches You and You Fall Down" (Book Review)

By Tercius

In the early 1980s, the Lee family-husband Nao Kao, wife Foua, and their six surviving children-escaped from the Communist regime in Laos and made their way to California's Central Valley, where many other Hmong refugees had resettled. In 1982, their daughter Lia was born. Unlike her parents and her twelve brothers and sisters before her, who were delivered into their mother's hands as she squatted alone and silently over a dirt floor, Lia was born in a modern public hospital, where her mother lay on her back on a steel table and gave birth to her baby into the hands of a doctor.

At the age of three months, Lia started having severe epileptic seizures. Her parents would take her to the hospital to get help, but they did not speak English and they did not trust the doctors or understand the complicated treatment she received. Anne Fadiman's book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures chronicles the Lees' confusing and often terrifying odyssey through the American medical system.

The book highlights the enormous differences between the Hmong mindset and the American mindset. Even the title speaks of a fundamental difference in the way epilepsy is viewed in the two cultures; while American medicine sees it as a physical disorder caused by abnormal neuronal activity, Hmong people attribute it to spiritual forces. The book is sensitively and fairly written, with a balanced presentation of the perspectives and perceptions of both cultures. The author expressed her thanks to the Lee family, "who changed my whole way of looking at the world when they welcomed me into their home, their daily lives, and their rich culture." (page 329) If you read her book with an honest, open mind, it will make you rethink your own assumptions about what constitutes good medical care, what makes a healthy family, what it means to be a good parent, and even what is the nature of truth.

Having been in an intercultural marriage for more than 40 years, I am well aware of the fact that huge misunderstandings in a relationship can be generated by our cultural biases. The partners may not even be consciously aware of the presuppositions and expectations they bring into the marriage, but their words and actions spring from the basic beliefs they hold. The less they have in common, the greater the potential for misunderstanding and conflict, and for comedy but also tragedy.

Missionaries going into a foreign culture also need to understand this phenomenon. I think The Spirit Catches You and You Fall Down should be required reading for missionaries. Not that every foreign culture is like the Hmong, but this book alerts you to the fact that vast differences do exist between cultures. It helps you get into the mind and heart of someone who thinks and feels and experiences life very differently. As the author asks, "If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" (page 261)

In particular, medical missionaries would benefit from this book. I got it from my son Alex, who is a med student and is interested in cross-cultural medicine. As the author points out, healing must involve much more than applying technology and administering drugs; healers must show "a concern for the psychosocial and cultural facets that give illness context and meaning" (page 265). Those who want to minister to the whole person-body, soul, and spirit-will be most effective if they can truly walk in the other person's shoes and understand how the other person thinks.

God Himself is the model for entering fully into the life of others. He could have stayed in heaven, but He chose to become flesh and dwell among us and experience human existence fully. He understands us not only because of His omniscience, but also because He humbled Himself and became a human being, taking on our limitations and seeing life through our eyes. May He open our eyes to understand others and to know how to communicate to them the good news of His coming to earth to live and die for us.

Spoiler Alert: If you want to read the book yourself and find out what happens to Lia Lee, stop here!

Lia's seizures became increasingly frequent and severe, despite the medical community's best efforts to help her. At one point, doctors and social workers decided that her parents were not being compliant enough with the prescribed treatment (which in the parents' view was making her worse), and Lia was removed from her home and placed in a foster home for nine months, to the unbearable anguish of her family.

At the age of four, Lia suffered a grand mal seizure that the doctors were unable to control. She was left in a persistent vegetative state, and there was nothing more that American medicine could do for her, so she was sent home to die, which doctors believed would happen imminently. But in the loving care of her family, Lia lived for 26 more years, finally passing away last August at the age of 30. Throughout that time, Lia's family practiced their traditional rituals, which are extremely suspect in the eyes of the American medical establishment, but they treated her with utmost dignity and nurtured her with tender compassion.

So what was the "right" way to treat a patient like Lia? I hope you come away with the realization that there are no easy, cut-and-dried answers. I hope you will also have a greater appreciation of the richness of different cultures and will make a concerted effort to understand others who may be very different.