“The Spirit Catches You and You Fall Down”, by Anne Fadiman is the story of Lia Lee, a Hmong child with epilepsy, and her tragic outcome due to lack of cross-cultural competency in medicine. Lia, suffering from a rare form of epilepsy, began experiencing seizures at the age of three months. The moves through Lia and her family’s experiences as well as the medical doctors involved in here case. From the beginning of Lia’s treatment there are severe differences in the manner in which her condition is interpreted by doctors and by her family. While doctors define Lia’s condition as being a form of epilepsy, her family interpret the disease through their beliefs as Hmong which is known as “qaug dab peg” or “the spirit catches you and you fall down” (Fadiman, 1997).
The story centers on Lia but defines the Hmong culture through her and her family’s interactions with the tvix neeb or shaman. There is conflict of understanding taking place between the western trained doctors and the shamans as they both attempt to treat the child. This lack of cultural understanding would lead to a series of negative outcomes such as Lia being hurt both physically and mentally due to lack of treatment with medicine.
The Shaman is the key figure in the story. While author Fadiman presents the problem as a cultural misunderstanding, it is difficult as a westerner to feel empathy towards the belief system of the Hmong. This problem is due to the fact that the practices of the shaman appear to be so archaic and barbaric in contrast to taking a pill which would have saved Lia’s life. However, this prejudice or bias in perception is exactly the issue that Fadiman is relating. She shows throughout the story such as when she approaches a doctor familiar with the Hmong and begins discussing the cultural differences of medicine:
“Knowing she had worked with the Hmong, I started to lament the insensitivity of Western medicine. The epidemiologist looked at me sharply. “Western medicine saves lives,” she said. Oh. Right. I had to keep reminding myself of that. It was all that cold, linear, Cartesian, non-Hmong-like thinking which saved my father from colon cancer, saved my husband and me from infertility, and, if she had swallowed her anticonvulsants from the start, might have saved Lia from brain damage.” “en influenced by economic factors (managed care plans prefer primary to sub-spec” (Fadiman, 1997)
The shows Hmong shamans in a more critical view than what the doctors and most Americans are seeing them. While to many Americans, the shaman appears to be some form of witch doctor, he actually reflects a much more complex view of life and the universe. The Shaman and the Hmong see all aspects of life interconnected with the spiritual aspects being equally as important as other. There is no mental illness in the Hmong religion because all disease or sickness is caused by some spiritual issue. This raises the Shaman to a revered and essential member of the culture. The Shaman is able to heal, act as spiritual guide, psychiatrist, and as community leader. Denying this position of the shaman in the Hmong community only serves to further divide western medicine from the Hmong.
Fadiman, A. (1997). The Spirit Catches You and You Fall Down. New York, NY: Farrar, Straus and Giroux.
Hmong Girls in Thailand By Xavier Romero-Frias — Own work, CC BY-SA 3.0