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

By Anne Fadiman
Reviewed by Christie Keith

In 1991, three-month-old Lia Lee, the daughter of recent Hmong immigrants from Laos, was diagnosed with epilepsy. From that day on, her life became a symbol of the vast chasm separating her American medical doctors and the values and traditions of her Hmong culture.

The single most notable feature of author Anne Fadiman’s National Book Critics Circle Award-winning book is the raw objectivity with which she portrays the characters in this tragedy. She neither demonizes nor canonizes anyone; there is no hero, no villain, and no clear course that could have been followed to avoid the book’s tragic outcome.

The Hmong word for “seizure” gives this work its title: The Spirit Catches You and You Fall Down. To the Hmong, all physical disease is at its root spiritual disease; the spirits and divinities are alive, involved in the lives of human beings, and often far from benevolent. Little Lia may be paying for a mistake made by her parents, or perhaps suffering the consequences of the half a world that separates her family from its homeland in Laos. For Lia’s spiritual illness, her family seeks a spiritual cure.

The medical doctors to whom Lia is brought when she begins seizing as an infant have their own worldview. Although at first they misdiagnose and mistreat the sick infant, they eventually diagnose her as severely epileptic. They see Lia’s problem as a physical one, and seek to find the right combination of physical substances to suppress the errant impulses of her brain. But they have no tools with which to communicate with the Lees; not only do they not understand their culture or their worldview, they don’t even have on staff anyone who can speak their language.

The next few years find Lia’s condition gradually worsening, until the child is actually taken away from her family and placed in foster care, for her own good. Obviously, the well-intentioned social workers believe, the Lees either will not give Lia her medication, or don’t understand how to follow the doctors’ instructions. And yet, in foster care, on a closely followed regiment of western medications, Lia’s condition actually worsens. The foster mother becomes close to Lia’s family, and becomes one of the strongest advocates for returning the child to their care.

At the age of 7, Lia’s western doctors give up on her, dismissing her as brain dead and sending her home to die. But in 1988, when Fadiman goes to the Lee’s home and meets Lia, the child is alive and well-cared for, although functioning at the level of an infant. Her family carries her, dresses her, loves her, caresses her, includes her in their family life, and continues to work within their own spiritual tradition to find Lia’s wandering soul and draw it back home to her body.

Kirkus Reviews called The Spirit Catches You and You Fall Down “a brilliant study in cross-cultural medicine,” and it serves well as a guide to Hmong history, culture and religion, the traditions of American medicine, and the border where they meet. But Fadiman has written also the profile of a fascinating medical case, the history of a family, and a story about love. It will deeply and permanently impact everyone who reads it, and change forever our views of medicine, health care, spirituality, and family.

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