The circumstances that led to me reading Anne Fadiman’s The Spirit Catches You and You Fall Down over the winter holidays were nothing if not unlikely. Originally released in 1997, the book first caught my eye in the early 2000s on a coffee shop bookshelf in my hometown. I was only in elementary school back then, but even at that young age I recall being captivated by the concepts of culture clash and intercultural miscommunication recounted on the book’s back cover. I knew my mother would never let me read such an “adult” book as young as I was, and as such, I made a resolution to myself that someday I would find Fadiman’s book once again and make it a point to read it. Now — about fifteen years later by my count — I have accomplished that objective.
The thrust of The Spirit Catches You and You Fall Down concerns Fadiman’s case study of Lia Lee, an epileptic child growing up in 1980s Central California. Lia was a member of the Hmong ethnic group, her family part of a mass exodus of Hmong who immigrated to the United States in the 1970s and 1980s after participating in the Vietnam War under clandestine direction from the CIA. Hmong religious tradition suggests that many illnesses are spiritual rather than physical; the title of the book is a translation of the Hmong word for “epilepsy,” and refers to the condition in which a sufferer’s soul is snatched by an evil spirit. Lia’s parents came from a rural mountain village in Laos where shamanistic beliefs were strongly held. These same beliefs made the couple hesitant to treat their daughter’s epilepsy, as in Hmong tradition some epileptics go on to become shamans themselves.
Lia’s parents did seek medical attention for their daughter, but her case is a tragic history of missed opportunities, miscommunications, inadequate hospital infrastructure in the face of a migrant crisis, and healthcare professionals improperly trained in dealing with patients from outside their own culture. For example, Lia’s family was regularly requested to consent to procedures and to sign documents in English, a language which they could not read, write or speak. Healthcare staff, for their part, were frustrated at the parents’ noncompliance with Lia’s complex medication regime and home health recommendations. The situation spiraled out of control over a period of several years, eventually culminating in a grand mal seizure and subsequent hospitalization that robbed Lia of any chance at a normal life.
The new afterword in my edition of The Spirit Catches You and You Fall Down mentioned that since its release, Fadiman’s book has become required reading in many medical ethics and medical communications courses. I am honestly quite relieved to hear this, because at the time of the book’s original publication in 1997, the state of intercultural medicine in America sounded somewhat bleak. Although it is clear that significant strides have been made, from the availability of translators to increased empathy for nontraditional religious beliefs (within “reason”), modern medicine still has a long way to go in order to meet people like the Lee family halfway.
As for my impressions of the work itself, even though it took me fifteen years to finally sit down and read The Spirit Catches You and You Fall Down, I am very glad that I sat down and took the time to do so. Fadiman effectively interweaves the story of Lia’s medical history and her family’s immigration to the United States with the larger narrative of the Hmong ethnic group as a whole and their participation in the Vietnam War, a subject which I heretofore knew nothing about. I learned, for example, that many Hmong suffered from PTSD just as Vietnam War veterans did, and that many so-called “Secret War” veterans had been informally promised pensions in the United States by the CIA, only instead to receive public assistance and the discrimination it brought against their community. Although I am not a medical professional, reading the work certainly gave me a greater appreciation for the plight of refugees, both in the struggles they face in their homeland and in their new homes overseas.
In conclusion, then, I would offer a resounding recommendation of The Spirit Catches You and You Fall Down to all medical professionals and medical students, intercultural communication professionals, students of Southeast Asian history, and concerned citizens seeking a form of insight into the current refugee crisis in Europe.
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