Two diverse cultures collide in different aspects to ruin a young girl’s life in Ann Fadiman’s book “The Spirit Catches You and You fall Down.” The book is a story of the Lee family. It is a Hmong family, living in Merced, California. The Lee family emigrated from a refugee’s camp in Thailand, where they sought refuge from the embattled mountains in Laos in the early 1980s. The story of the Lees family begins with their journey to America, and develops to explore their subsequent struggles in America, especially the struggle with their epileptic daughter Lia.
After being diagnosed with epilepsy, she was given prescriptions to help manage the seizures, but her family did not give her the medication, as it was required. Lia’s parents did not comply with the doctor’s instruction, partly because of ignorance, and partly because they thought that the “western” medications were only making their daughter’s condition worse. At some point, doctors recommended to put Liabe under Foster Care to ensure she is given the medication as stipulated, although her seizures did not stop. The book presents a drama, emanating from a clash of cultures and knowledge, in addition to case management challenges in Lia’s epilepsy case. The cultural conflict developed when doctors prescribed Valium and Depakene to help control the seizures, but the Lee’s family thought her soul was lost and could be restored by animal sacrifices and intervention of shamans.
Contrary to previous births in her family, Lia was born in Merced Community Medical Centre as the Lee’s believed it was fundamental for the newborn to acquire citizenship. The baby appeared healthy, with no birth complications. About three months later, Lia had her first seizure at infancy. The doctors later diagnosed her with epilepsy, which they explained as a physical disease of the nervous system. On the contrary, from a cultural viewpoint, the Hmong people believed that seizures occurred in the spiritual realm, symbolizing a condition deserving reverence. Lia’s parents, Foua (mother) and Nao Kao (father) though the seizures resulted from a spirit named “dab”, capturing Lia’s soul and refusing to return it to her. There was a misinterpretation and miscommunication between the physicians and the Lee family, resulting from the language barrier, and, most importantly, their cultural systems.
Fadiman’s book narrates the story of two incompatible cultural realities - the Hmong animism and the western Rationalism. These cultures contentiously crash into each other in the detriment of Lia, whose wellbeing is entirely dependent on their harmonious collaboration. The two realities fail to help Lia due to lack of harmony and collaboration, as depicted by the author. There is mutual misunderstanding, and suspicion, in addition to prejudice of the other culture. It is imperative for one to recognize that Lia’s harm was not a result of a biological pathology, but a cultural pathology. The Author notes that “Lia’slife was not ruined by septic shock or non-compliant parents; it got ruined by the cross-cultural misunderstanding”.
From a physician’s point of view, Lia’s medical condition was curable in the sense that the seizures could be stopped or at least mitigated. Although the doctors did not know the exact cause of the illness, they had a way to cure it, and give Lia a chance to lead a better life, despite the fact that she was epileptic. Lia’s parents also had a point of view which was different from what the western doctors said. The parents believed that Lia’s seizures resulted from “quag dab peg,” which translates to “the spirit catches you and you fall down”. Her parents believed that the spirit had captured their daughter’s soul and refused to return it. They had a remedy for the situation, according to the Hmong cultural beliefs and tradition. The cure involved animal sacrifice and getting shamans to intervene and help find and restore Lia’s soul. There is a conflict between the western and eastern healing methods, and Lia’s parents find themselves in between the conflicting approaches to heal their daughter. They “tried” the western medication, but they noticed that the medication was only making their daughter feel worse, - probably because they did not give her the medicine, as doctors had prescribed.
The aspect of cultural predicament is also influenced by the language barrier. When the doctors recommended that Lia should be put under foster care, they cited that the Lees were unable to read and interpret English directions written on Lia’s prescription bottles. As a result, Lia was not taking the prescribed Anti-seizure medication as specified. The hospital did not have a Hmong-English translator, or bilingual Hmong employee to work during the night. As the author notes: “Doctors on the late shift in the emergency room had no means of taking the patient’s medical history or asking such questions like where do you hurt?” There were difficulties in communicating the vital information. Lia’s parents could not speak English, thus, could not excellently provide the details of her seizures, and even the fact that she had seizures. Initially, the doctors had misdiagnosed Lia’s symptoms as “bronchial infections.” The doctors did not initially realize that Lia’s Bronchial problems were caused by seizures, and her seizures went untreated for months. As Neil Ernst, one of the doctors who treated Lia recalls, Lia’s prognosis could have been much better if she had been diagnosed correctly and received appropriate medication from the beginning.
In a different case of cultural dilemma, way back before the Lee family had even considered moving to the United States, they heard “bad” rumors about the doctors in the United States. These rumors alleged that doctors in the U.S take blood from people, including children; doctors take organs from their patients and sell for food, doctors anesthetize patients putting their souls at large, which could cause illnesses or deaths. Hmong people believe that the human body contains a finite amount of blood that is not replaceable; therefore, removing blood from a person could lead to their weakening and death. On the same note, in the western world, people actually donate blood to save other people’s lives, which conflicts the Hmong cultural beliefs. Here, the doctors (and any other civilized person) can only consider the Hmong to be ignorant, primitive or backward, and too reliant on animal sacrifices. Such traditional practices are deemed obsolete in the contemporary world.
The western and the Hmong cultures could not allow the physicians and the Lees provide the ailing girl with the help she needed. None of them realized that their view of reality was not necessarily true. They both failed Lia because they were both prejudiced. The Lee family assumed that the doctors medication were “bad’’ for their daughter. The doctors assumed that because of their high-level training, “their help would be appreciated, their treatment would be utilized and their authority would be respected. The doctors kept prescribing medicine to her (including surgery and blood tests) without considering the traditional beliefs of the Hmong.
If the doctors who treated Lia worked closely with her family and their religious framework, and practice a conjoint treatment, they could have been able to treat her in a more successful way. They could have bridged the religion-cultural gap, as the Hmong people believe in the body to mind to spirit connection. At the climax of the story, Lia gets the “big” seizure that ultimately puts her in a vegetative state, and the seizures stop. Her family believes that she is “cured,” when the seizures stop and they are allowed to take her home. The family took care of her with lots of love and hope. The Lee family believed she was healed, while the doctors did not imagine that Lia would live longer than few months, but she lived for years.
In conclusion, the book offers an exceptional writing and imperative advice on how to deal with cultural discord. The life and health of Lia was compromised, as a result of cultural dissonance. The story is a wakeup call for the need for better cultural competence; in all contexts and fields (businesses, schools, hospitals and churches) that involve the interaction of people from different cultures. Improved cultural competence will result in shared wisdom and mutual respect, in addition to significant collaborative achievements. I agree with the Fadiman on the point that Lia’s life was not ruined by the epilepsy she was diagnosed with, or non-compliant parents, but by cross-cultural misunderstandings. The doctors were well trained and professional in their work but by the end of the story, they only amount to “imperfect healers.” Fadiman advocates for “conjoint treatment” – the combination of western medicine and the traditional healing arts, such as allowing family members and shamans to stay with Lia. As much as the western way of tackling medical problems is considered modern, accurate and the best, the doctors should acknowledge that there are other people from different cultures that do not share the same views. Other important things raised by Fadiman include providing bilingual and bicultural interpreters to help bridge the gap in communication between the Hmong people and the doctors. The medical practitioners, from all over the globe should adopt the concept that one’s view of reality is simply a view but not the reality itself.