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The Spirit Catches You and You Fall Down

Awards: National Book Critics Circle Awards - Winner, General Nonfiction; Boston Book Review - Winner, Nonfiction; L.A. Times Book Prize - Winner, Current Interest

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About The Author

Anne FadimanAnne Fadiman

Anne Fadiman was born in New York City and was raised in Connecticut and Los Angeles. After graduating from Harvard, she worked as a wilderness instructor in Wyoming before returning to New York to write. She has been a staff writer at Life, editor-at-large of Civilization,... More

photo: Connie Miller


National Book Critics Circle Awards - Winner, General Nonfiction
Boston Book Review - Winner, Nonfiction
L.A. Times Book Prize - Winner, Current Interest

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Reading Group Gold

This guide is intended to enrich your experience of reading The Spirit Catches You and You Fall Down, winner of the National Book Critics Circle Award. This moving chronicle of a very sick girl, her refugee parents, and the doctors who struggled desperately to treat her becomes, in Anne Fadiman’s deft narrative, at once a cautionary study of the limits of Western medicine and a parable for the modern immigrant experience.

Lia Lee was born in the San Joaquin valley in California to Hmong refugees. At the age of three months, she first showed signs of having what the Hmong know as qaug dab peg (the spirit catches you and you fall down), the condition known in the West as epilepsy. While her highly competent doctors saw the best treatment in a dizzying array of pills, her parents preferred a combination of Western medicine and folk remedies designed to coax her wandering soul back to her body. Over the next four years, profound cultural differences and linguistic miscommunication would exacerbate the rift between Lia’s loving parents and her caring and well-intentioned doctors, eventually resulting in the loss of all Lia’s higher brain functions. Fadiman weaves this personal tragedy, a probing medical investigation, and a fascinating look at Hmong history and culture into a stunningly insightful, richly rewarding piece of modern reportage.

Questions and Topics for Discussion

The two cultures

1. Do you think the author was evenhanded in her presentation of Hmong culture and medical

2. The book contains many Hmong phrases and many medical phrases, both unfamiliar to most readers. Why do you think the author included them?

3. Over the centuries, the Hmong fought against many different peoples who claimed sovereignty over their lands. What role has this tumultuous history played in the formation of Hmong culture?

4. How does the Hmong folktale about how Shee Yee fought with nine evil dab brothers, told at the end of chapter 12, reflect Hmong culture?

5. What do traditional Hmong consider their most important duties and obligations? What do American doctors consider their most important duties and obligations?

6. In chapter 18, Fadiman writes, “As William Osler once said—or is said to have said—‘Ask not what disease the person has, but rather what person the disease has.’” How might the events of this book have unfolded if Osler’s dictum were universally followed in the medical profession? How would your relations with your own doctors change?

7. In matters of attitude, what might the average American doctor learn from a Hmong txiv neeb (shaman)? What might the txiv neeb learn from the doctor?

8. In her preface, the author says that while she was working on this book, she often asked herself two questions: “What is a good doctor?” and “What is a good parent?” How do you think she might have answered her own questions? How would you answer them?

9. At the end of chapter 18, Sukey Waller asks, “Which is more important, the life or the soul?” What do you think?

The characters

10. The Spirit Catches You and You Fall Down revolves around a small child who for much of the book is too young to speak for herself, and at the end is unable to. Do you nonetheless feel you know Lia Lee? Do you believe that even though she cannot walk or talk, she is a person of value? Why?

11. In chapter 8, after describing Foua’s competence as a mother and farmer in Laos, Fadiman quotes her as saying, “I miss having something that really belongs to me.” What has Foua lost? Is there anything that still “really belongs” to her?

12. How do you feel about the Lees’ reluctance to give Lia her medicine as prescribed? Can you understand their motivation? Do you sympathize with it?

13. In chapter 7, Neil Ernst says, “I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids’ lives.” Why didn’t this message get through to the Lees? If you were Neil, would you feel this way too?

14. In chapter 15, Foua, who has heard that one of the Ernst sons has leukemia, embraces Peggy. After all the conflict between them, why are they finally able to resolve their differences? Do you think this could have happened earlier?

15. Since the publication of the book, Anne Fadiman has said that if she lived in Merced, she would choose Neil and Peggy as her children’s pediatricians. Would you?

16. Fadiman describes May Ying Xiong as not just an interpreter but a cultural broker. What’s the difference? What were May Ying’s contributions to the book?

17. Were you surprised by the quality of care and affection given to Lia by her foster parents? How did Lia’s foster parents feel about Foua and Nao Kao? Was foster care ultimately to Lia’s benefit or detriment?

18. The only American who fully won the Lees’ trust was Jeanine Hilt, their social worker. Why did Jeanine succeed where so many others had failed?

19. The book contains brief but important sections on three Hmong leaders—Jonas Vangay, Blia Yao Moua, and Dang Moua—who are multilingual and gainfully employed. What did they teach Fadiman? Why did she include them?

The writing

20. How might this book have been different if it had been written by a Hmong? A doctor? An

21. From a writer’s point of view, what are the advantages and disadvantages of being an outsider in the two cultures Fadiman explores?

22. “The spirit catches you and you fall down” is a literal translation of the Hmong phrase for epilepsy. Why do you think the author chose such a long and difficult title?

23. The book has an unusual structure: Lia’s story occupies the odd-numbered chapters, and background material occupies the even-numbered chapters. Why do you think Fadiman organized her narrative this way?

24. At the beginning of chapter 2, Fadiman tells the story of a Hmong student who gave an oral report on Fish Soup. What is the concept of “fish soup,” and how is it reflected in the book itself?

25. One of the ways by which Fadiman places the doctors and the Lee family on equal footing is her decision to refer to all of them by their first names (instead of saying, for instance, “Dr. Ernst”). What are some other ways?

26. Many readers have commented that The Spirit Catches You and You Fall Down is a book without villains. Do you think that from a literary point of view this is a flaw?

Other Books of Related Interest

Virginia Barnes Lee, Aman: Story of a Somali Girl; Michael Bérubé, Life as We Know It; Robert Olen Butler, The Deep Green Sea; Lan Cao, Monkey Bridge; Temple Grandin, Thinking in Pictures: And Other Reports from My Life with Autism; Jamaica Kincaid, My Brother; Maxine Hong Kingston, Woman Warrior; Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales; Esmeralda Santiago, When I Was Puerto Rican; Susan Sheehan, Is There No Place on Earth for Me?; Abraham Verghese, My Own Country: A Doctor’s Story.

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