The Spirit Catches You and You Fall Down: Between Two Different Worlds and Cultures

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Anne Fadiman did a remarkable presentation of The Spirit Catches You and You Fall Down.  She carefully, without prejudice to either party, shared the intimate story of a young Hmong child torn between two different worlds and cultures.  Ultimately, through many struggles suffered by all involved, the outcome was that these two different cultures deeply cared for and loved the same sick little girl in the best ways they each knew how. 

For us to utterly understand the Hmong culture, Fadiman reveals her thorough studies of who the Hmong are.  The Hmong people date back into the B.C. time, but Fadiman chose to start studying the Hmong a few hundred generations back when they were living in the river plains of north-central China.  After battling and refusing to succumb to Chinese ways for many centuries, many of the Hmong migrated to Laos and Vietnam, and later to Thailand.  They were known to never surrender, but more likely to fight or flight, remaining extremely independent of themselves and their own culture.

Fadiman describes the Lees’ homeland in Laos and what life was like for them there.  She brought to life what it would be like to give birth to her first twelve children squatting on a clean, dirt floor in her house built by Lia’s father, Nao Kao.  As a mother myself, I was amazed how simply, and quietly Lia’s mother, Foua delivered her own children actually guiding their head and body out herself as “her older children slept undisturbed on a communal bamboo pallet a few feet away and woke only when they heard the cry of their new brother or sister” (Fadiman, 2012, p. 4).  I was also intrigued by the different birth customs, such as why and where they would bury the placenta. 

On the contrary to Foua’s traditional birthing process, Lia, the fourteenth Lee child, was born in Merced, CA at a public hospital named Merced Community Medical Center (MCMC).  Fadimen used great detail to describe how different this birth was, “Foua, was lying on her back on a steel table, her body covered with sterile drapes, her genital area painted with a brown Betadine solution, with a high wattage lamp trained on her perineum” (Fadiman, 2012, p. 6).  The Lees came to the United States in 1980.  Foua’s birth experience at MCMC epitomizes how different Western Medicine and culture is compared to Hmong culture and life as the Lee family knew it in Laos.  Foua had no way to communicate with the staff at MCMC about her traditional births, even if she had wanted to.  Fadimen’s detail to these events is just the beginning of showing what it is like for the Lee family coming to live in a well-developed country that is unable to relate to their different, yet simple and intimate culture. 

Lia was three months old when she had her first seizure.  As readers, we can understand that epilepsy in the Hmong culture is thought to be spiritual, and through Fadiman’s descriptive writing, we learn so much about the Hmong’s belief in animism.  She uses several examples throughout the text of how Hmong’s relate to spirits and souls, whether it is burying placentas or sacrificing animals.  They connected their way of birth, life, and death to spiritual beliefs.  Qaug dab peg, which means “the spirit catches you and you fall down” is how the Hmong culture views epilepsy.  They see it more as a blessing, rather than an illness because of their spiritual connectedness.

  I can surely appreciate the Hmong’s spiritual beliefs because Fadiman represented them so well with the multitude of examples she used.  She relayed that only one person, Jeanine Hilt, a social worker, ever asked the Lees what they thought caused Lia’s illness, “They felt Lia was kind of an anointed one, like a member of royalty.  She was a very special person in their culture because she had these spirits in her and she might grow up to be a shaman, and so sometimes their thinking was that this was not so much a medical problem as it was a blessing” (Fadiman, 2012, p. 22).  It was clear that the Lees chose to treat their child and that western medicine was only looking to treat the illness.  Lia’s healthcare providers wanted to control her epilepsy the best way they knew how with diagnosis and medication.  Lia’s parents, that purely loved her beyond doubt, had Lia’s wellness in mind, but they still believed more in healing her spiritually and with ritualistic treatment, over western medicine. 

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Fadiman represented the Hmong culture so well, but as much as their world collided with Lia’s American doctors, Fadiman was able to appreciate how hard Lia’s doctors fought to help this child just as well.  You could feel their frustrations while reading their fears for Lia and her epilepsy.  As a healthcare professional, it was quite impressive how well Fadiman, a non-healthcare professional, thoroughly wrote about Lia’s medical treatment.  She was as detailed about her medication names, doses, side effects, and diagnostic results as she was about the array of details she shared concerning the Hmong’s culture and way of life.  These two worlds did not collide for lack of caring for Lia, but for lack of understanding the ways to do it.  Lia was not diagnosed correctly until her third hospital visit.  It was the first time she came in and she was still seizing.  Dan Murphy was the doctor on at the time.  Fadiman (2012) summed up this cultural barrier perfectly:

 Dan had no way of knowing that Foua and Nao Kao had already diagnosed their daughter's problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological disorders. Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia's parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter's head that had been stirred up by the misfiring of aberrant brain cells. (p. 28)

One of the strongest parts of Lia’s story that brought to life the reality of this confusion was when Lia was placed in foster care because her parents were considered noncompliant and neglectful.

            Dr. Neil Earnst and his wife Peggy Philp were both on the faculty of the family practice residency program at MCMC.  Both cared endlessly for Lia during her many hospital visits and admissions.  Lia was nearly three years old when Neil filed a report with Child Protective Services.  Lia was with the Korda family.  Although they were following Lia’s medication regimen Lia and had more seizures than she had in the Lee’s care.  The Korda family was very fond of Lia, regardless of her being such high maintenance medically and behaviorally.  The Lees visited with the Kordas every chance they could.  The Kordas eventually allowed the Lees to babysit their own children, which had never happened before in a foster care case.  After the Kordas suggested that the Lees were beyond capable of caring for and loving Lia, the Lees were able to bring Lia home.  This was a true testament of their love for Lia and I think this was a major breakthrough for both the American medical profession and the Hmongs. 

Lack of understanding played its toll on the medical profession, the Lees, and most of all on Lia.  The tug of war between the doctors finding Nao Kao and Fuoa to be non-compliant, and Nao Kao and Fuoa not trusting the medical treatment, was expected.  I did not expect to find how much they would come together through all of this.  All of the frustration and misunderstandings they shared were so real and yet Lia’s life changed everyone she came in contact with for the better.  In tragedy, the love seemed greater. 




  1. Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York, NY: Farrar, Straus & Giroux.
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