The Spirit Catches You and You Fall Down by Anne Fadiman is one of the modern classics in the medical anthropology genre. Tracing the immigration and the challenges of assimilation of a Hmong family into the USA, the book is admirable on many counts. Firstly, for medical professionals, it offers valuable insights into the symptoms, treatment options and overall management of epilepsy in children. Second, it presents the unique challenges faced by health care professionals in a multi-cultural environment. Third, the book documents the broader details of Hmong ethnography, adopting classical anthropological approaches. The rest of the essay will elaborate these features, as well as noting the personal and professional impact the book has had upon the writer.
The central dialectic in the book is how the shamanistic animism followed by the Hmong conflicts with the rationality of Occidental medicine. While the cultural heritage of the Hmong is rich and colourful, it betrays its superstitious underpinnings when juxtaposed with modern scientific knowledge and advancement. In other words, in light of our overall increase in the knowledge of the world, much of the Hmong beliefs appear mythical. In the classic case of conflict illustrated in The Spirit Catches You, we see how Hmong culture is markedly at odds with modern science. While in most facets of life this divergence is only of academic interest, in critical areas such as medicine it can be highly significant. Indeed, it is fair to say that the Hmongs’ adherence to their traditional world view hinders proper medical diagnosis and treatment. In other words, the tragic surrender of the young Lia Lee to epilepsy is not a testimony to the limitations of health sciences. To the contrary, it is the consequence of the closed-mindedness of a primitive community, whose old-world charm can so easily prove self-defeating.
What I like about Anne Fadiman’s work is how it places the endogenous anthropological study of the Hmong in the modern geo-political context. For example, Fadiman ties the consequences of the US imperial project with the tragedy incurred by the Lees. After a cursory glance at the case, it is easy to be critical of Hmong culture and blame the Lee family for their tragedy. But a larger view of the event will bring to bear the overall education standards in Laos as well as the influence of American imperialism in indirectly influencing the outcome. It is important to scrutinize the moral and legal merits of America’s active involvement in the war in Laos. Political scientists have termed America’s participation as morally vapid and legally dubious. One of the attendant consequences of the war-ravaged Laos is the collapse of social infrastructure, including the education system in the country. The Lee family can count themselves as victims of this loss to their nation. In this milieu, what opportunity they would have otherwise had for developing their critical thinking faculties and a scientific temperament were nullified. So, when the family migrated to the United States as refugees, they could not but carry with them their primitive belief set which were to prove lethal for the ailing young Lia. Whether the particular case of Lia would have unfolded any differently in a free and sovereign Laos is a moot question. The emphasis here is one of assigning moral responsibility for a tragedy and not about statistical probability. On this count, the United States, being the decided aggressor vis-à-vis Laos, is surely guilty. One way of making amends for this guilt would have been to show cultural sensitivity and compassion. But, in reality, the healthcare professionals who treated refugees from Laos showed a complete ignorance of Hmong culture and contempt of their beliefs. Fadiman’s multilayered interpretation of the medical event, drawing deeply from cross-disciplines in humanities, is something I admire in the work.
Another of the notable features of the book is how it contains information well and beyond the medical case. Although the medical case is the pivot upon which the narrative is based, the author endeavours to meet a larger objective. The objective is that of showcasing the cultural and historical roots of the Lee family and the Hmong community. The author is to be commended for using a simple jargon-free language while explaining the medical complications of Lia. The accessibility of the language makes the book a ready reference for lay readers and scholars alike.
True to being an objective writer, Fadiman avoids taking sides in the cross-cultural conflict between the two parties. What sympathy there is in the work is purely on humanitarian grounds. The author also makes sure that her own personal ethnographic background does not colour the scholarly treatment of an exotic and strange community. Moreover, the facts surrounding the case of Lia Lee are presented along with the social science theories relevant to them. For example, ‘cultural relativism’ is a persistent theme in the book, which is explained in the abstract as well as concretized through the example of the case study.
The author is to be commended for understanding and anticipating the needs, positions and perspectives of her target audience. Considering that her work were to be read largely by an Anglophone readership, mostly from the USA, UK and the Commonwealth, she puts in additional effort in disabusing the reader of myths and misconceptions surrounding Hmong culture. For the Occidental mindset, the shamanistic animism that drives Hmong lifestyles might appear nonsensical or counterproductive. But in the socio-geographic milieu of native Hmong tribes, where nature is an integral part of life, apparent superstitions have a veiled logic. In many ways, the perception of the Hmong suffers from the same prejudices that resulted in the mass extermination of Native Americans. The tragic case of Lia only reinforces the fact that American society at large has not learnt its historical lessons. It is these historical parallels that Fadiman draws to caution Americans from repeating injustices.
The most important lesson I would extract from the book is that compassion should be the code word for all social interaction. This is especially true for American healthcare professionals, who, in their zeal to follow their trained procedures and upkeep their theories of medicine, can get tardy when it comes to genuinely caring for the patient. In the case of Lia Lee, there is no evidence that the medical staff attending her had been negligent or indifferent. To the contrary, every healthcare professional that the Lee family came in contact with appeared to have acted in the best interests of the ailing child. Yet, the tragedy unravelled as it did due to a lack of patience and perseverance in communicating with Lia’s family. Since the age of 4 and till her death at the age of 30, Lia had remained in a vegetative state. The fact of her protracted decline in a state of comatose only compounds the pain incurred by her parents. The magnitude of this tragedy forces one to hold somebody accountable. With the medical staff legally abdicated of guilt and the parents equally so, what is that one factor that could have changed the course of events? The resounding answer is the ‘compassion’. If only the doctors and nurses tried to see the point of view of Lia’s parents and tried to empathize with their feelings, a greater degree of communication would have been made possible. By simply eschewing the incomprehensible, the little girl’s prospects for life ended up being destroyed.
Fadiman dons several hats as an author. In its turn, she is an anthropologist, cultural theorist and psychologist. To give an illustration of Fadiman’s psychological acumen, we need to look at her deconstruction of the Lee family psyche. It is easy to criticize the Lees for their stubborn refusal to heed to professional advice. But when one considers their poor literacy level and minimal exposure to the broader world, they cannot be apportioned much blame. Moreover, however steeped in superstition the shamanic belief system might have been, it had served the community well for centuries. If survival and progeny across generations is the yardstick of success, then shamanism had guided the community through many a crises. So it does not naturally occur to the Hmongs to question the world view that they inherited from antiquity. I particularly appreciate Fadiman’s psychological insights such as these.
A recurrent theme of the book is that on ‘cultural dissonance’. This dissonance is at its most blatant when the two readings of Lia’s condition are polar opposites. For the Hmong, Epilepsy (‘quag dab peg’) is a stroke of good fortune. The epileptic fits of the individual are perceived as the spirit’s ability to enter her body and take possession temporarily. Thus individuals such as Lia are treated as mediums to connect with the supernatural world. Although the spirit in possession is deemed malevolent, it yet offers an opportunity for the community to communicate with the ethereal world. Such underpinnings of shamanistic animism are totally contrasted to the Western scientific understanding of the condition, which classifies epilepsy as a veritable pathology. Hence, despite the young Lia suffering enormously, her parents see her condition as providential. This made it harder for them to seek a cure with earnestness and expediency. Ironically, they were even hopeful that Lia would turn into one of those revered Hmong shamans who are believed to possess healing spirits. Lia’s parents were so caught up in their daughter’s prospects of being a communicator with the other world that they were blind to the critical exigencies of her medical condition. Anne Fadiman uses literary flourishes to describe these new and strange ways of thinking of an alien community. Further, she combines narrative elements with theories of anthropology and culture.
For me, one of the revelations of the book is how challenging it is to construct ethnographies. This is due to the fact that individual and communal experiences do not neatly fit into regular social scientific categories and logic. There is a strong emotive component that is instructed by social convention and historical heritage. Often these tendencies are counterpointed against progress and prosperity for the community as the case of the Lees amply illustrates. Nevertheless, it is not for the ethnographer to evaluate the moral merits of her subject. This much was exemplified by Fadiman herself in the distanced objectivity and professional rigor she brings to her craft. Moreover, Fadiman sees her work as a continuation or complementation of existing ethnographic accounts on the Hmong. For example, she gives credit to Keith Quincy’s anthropological study of the Hmong titled Hmong: History of a People. Fadiman considers her project as an extension of Quincy’s work. In recent years some factual discrepancies have emerged on Quincy’s work, especially relating to his theory that the Hmong originated from the northern Russian hinterlands. Fellow anthropologist Entenmann, in particular, set the record straight in this respect. The fact that Fadiman has accepted Quincy’s original theory should not detract from the veracity of numerous other citations she takes from the work.
Finally, the book’s utility for college courses cannot be overstated for it combines an in-depth case study with broader ethnographical treatise. It can thus be adapted into the curricula of various disciplines within health sciences and humanities. I personally enjoyed reading the book and would recommend it to fellow students. The book has informed me on the nature and composition of culture. It has offered me the understanding that culture is an endogenous product among a community of people contained in specific geographies. This milieu elicits an important practical question: Can the Hmong realistically expect to upkeep their native cultural identities in geographies as removed as the USA?
Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures, Published by Farrar, Straus & Giroux, 1997, Print.