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The Spirit Catches You and You Fall Down

January 17, 2011

I just finished reading The Spirit Catches You and You Fall Down by Anne Fadiman, and I can’t recommend it strongly enough.

As you can see, the front cover says, “A Hmong child, her American doctors, and the collision of two cultures,” which is a rough but fair summary.

The Hmong child is Lia Lee, born with severe epilepsy; the book’s title is the literal translation of the Hmong phrase for the condition.  Since it was published in 1997, the book has been well-received (and rightly so); no excuses for why I’m so late getting to it.

I’ll start out by saying that it’s a well-written, well-researched, insightful, and compelling book.  But there is a lot that makes it exceptional.  There are a multitude of angles at work: Lia’s parents’ interactions with her doctors in the 1980’s; the subsequent efforts of the author to gain the trust of both the Lee family and the medical community to research the book; an ethnography of the Hmong belief system; a history lesson of how the Hmong came to migrate to the US in such large numbers (more on that later);  and a complex look at the process of assimilation–for both immigrant communities and the communities that receive them.

Unfortunately, discussions of Lia’s story often describe what happened over the course of her medical treatment as a series of tragic miscommunications and misunderstandings.  And, in part, that’s true.  Yes, miscommunications happened when an interpreter wasn’t present (or even when an interpreter was present as the Hmong language lacks vocabulary for even the most basic organs).  And minsunderstandings based on false information abounded on both sides.  But Fadiman’s writing reveals another layer beneath language and facts–what are often fuzzily called “cultural barriers.”

I can think of several instances when I was living abroad or working with immigrant or refugee communities here in the States when despite what I thought was a crystal clear explanation, followed by another crystal clear explanation, preceded and followed by lots of questions on my part and that of the other party to ensure comprehension, the other person then went and did the exact opposite of what I expected (or I did the exact opposite of what they expected).  Every now and then, I managed to unravel what happened.  But usually, I just walked away frustrated and confused.

Fadiman takes years of these interactions, after which both parents and doctors are so confused and frustrated that  their willingness to share their story at all is a miracle, and pieces together what happened in the spaces between expectation and disappointment.

Lia’s parent’s “non-compliance” with her medications serves as an example.  Fundamentally, Lia’s parents believed that her epilepsy was the result of soul loss that occurred when Lia’s sister slammed the door too loudly and Lia’s soul was frightened out of her body.  While they didn’t want their daughter to suffer unduly, epilepsy also confers status in the Hmong culture as it increases the likelihood of the child becoming a shaman.  So while they wanted medical attention for Lia when aspirating a food particle during a seizure lead to pneumonia, they didn’t actually want the epilepsy completely cured and thought that medicines with negative side effects were unnecessary and, well, almost cruel.  The parent’s worst fear (that Lia’s soul would never return) and the doctor’s worst fear (that Lia would enter into a continuous unstoppable seizure) were so far apart that the pursuit of each worked at cross-purposes with the other.  Even absent Lia’s parent’s suspicion of the American medical system (which the side effects helped to fuel), they simply didn’t believe the doctors knew what was best for their child.  In return, the doctors’ lack of faith in the competence and care of Lia’s parents eventually escalates into her temporary removal from their care by Social Services.

With Fadiman’s careful unpacking, it all makes so much damn sense.  And, as the reader, you find yourself deeply empathizing with almost everyone.  But the narrative is long and complex, and Fadiman is unfailingly evenhanded–throughout the book, you can see her choosing phrases and frames with the utmost care.  I don’t think I could have made sense of the story without such a skilled guide, and that admission reminds me of how far I have to go.  I–and so many others who work across cultures–need to read more and more of these accounts, until the two-way decoding becomes an in-the-midst-of-chaos instinct.

I’ll be deep into migration over the next four months.  Next up on the reading list are The Warmth of Other Suns and Arrival City.

Jonas

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One comment

  1. […] (and better!) summary, Anne Fadiman gives a stellar primer on the subject, as I alluded to here.  The story actually first broke in 1987 when a British investigative journalist wrote The Ravens: […]



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