The Spirit Catches You and You Fall Down

"Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different."—Richard Bernstein, The New York Times

"One of the best books I've ever read."—Jane E. Brody, The New York Times

"If tragedy is a conflict of two goods, if it entails the unfolding of deep human tendencies in a cultural context that makes the outcome seem inevitable, if it moves us more than melodrama, then this fine book recounts a poignant tragedy . . . It is a tale of culture clashes, fear and grief in the face of change, parental love, her doctors' sense of duty, and misperceptions compounded daily until they became colossal misunderstandings. It has no heroes or villains, but it has an abundance of innocent suffering, and it most certainly does have a moral."—Melvin Konner, The New York Times Book Review

"An intriguing, spirit-lifting, extraordinary exploration of two cultures in uneasy coexistence . . . A wonderful aspect of Fadiman's book is her evenhanded, detailed presentation of these disparate cultures and divergent views—not with cool, dispassionate fairness but rather with a warm, involved interest . . . Fadiman's book is superb, informal cultural anthropology—eye-opening, readable, utterly engaging."—Carole Horn, The Washington Post Book World

"A unique anthropological study of American society."—Louise Steinman, Los Angeles Times

"Anne Fadiman's phenomenal first book, The Spirit Catches You and You Fall Down, brings to life the enduring power of parental love in an impoverished refugee family struggling to protect their seriously ill infant daughter and ancient spiritual traditions from the tyranny of welfare bureaucrats and intolerant medical technocrats."—Al Santoli, The Washington Times

"When the Lees hedged their bets in 1982 in Merced by taking Lia to the hospital after one of her seizures, everybody lost. Fadiman's account of why Lia failed to benefit over the years from Western medicine is a compelling story told in an achingly beautiful prose."—Steven Weinberg, Chicago Tribune

"Fadiman's meticulously researched nonfiction book exudes passion and humanity without casting a disparaging eye at either the immigrant parents who don't speak English, or the frustrated doctors who can't decipher the baby's symptoms . . . The Spirit Catches You and You Fall Down conveys one family's story in a balanced, compelling way."—Jae-Ha Kim, The Plain Dealer (Cleveland)

"So good that I want to somehow make it required reading . . . The Spirit Catches You and You Fall Down explores issues of culture, immigration, medicine, and the war in [Laos] with such skill that it's nearly impossible to put down."—Linnea Lannon, The Detroit Free Press

"This is a book that should be deeply disturbing to anyone who has given so much as a moment’s thought to the state of American medicine. But it is much more . . . People are presented as [Fadiman] saw them, in their humility and their frailty—and their nobility."—Sherwin B. Nuland, The New Republic

"A deeply humane anthropological document written with the graces of a lyric and the suspense of a thriller."—Abby Frucht, Newsday

"Fadiman's sense of reporting explores a vase cultural gap."—People

"The Spirit Catches You and You Fall Down is Fadiman's haunting account, written over a nine-year period, of one very sick girl in Merced, California . . . What happens to Lia Lee is both enlightening and deeply disturbing."—Kristin Van Ogtrop, Vogue

"Fadiman gives us a narrative as compelling as any thriller, a work populated by the large cast of characters who fall in love with Lia. This is a work of passionate advocacy, urging our medical establishment to consider how their immigrant patients conceptualize health and disease. This astonishing book helps us better understand our own culture even as we learn about another—and changes our deepest beliefs about the mysterious relationships between body and soul."—Elle

"The other day, I picked up a book I had no intention of buying. Eight hours later, having lifted my head only long enough to pay for the book and drive home, I closed Anne Fadiman's The Spirit Catches Your and You Fall Down and started calling friends . . . This is an important book."—Wanda A. Adams, The Honolulu Advertiser

"The Spirit Catches You and You Fall Down changed how doctors see themselves and how they see their patients. Anne Fadiman celebrates the complexity and the individuality of the human interactions that make up the practice of medicine while simultaneously pointing out directions for change and breaking readers’ hearts with the tragedies of cultural displacement, medical limitations, and futile good intentions.”—Perri Klass, M.D., author of A Not Entirely Benign Procedure

"This is a captivating, riveting book—a must-read not only for medical professionals, anthropologists, and journalists, but for anyone interested in how to negotiate cultural difference in a shrinking world. Fadiman's ability to empathize with the resolutely independent Hmong as well as with the remarkable doctors, caseworkers, and officials of Merced County makes her narrative both richly textured and deeply illuminating. Sometimes the stakes here are multicultural harmony and understanding; sometimes they're literally life and death—whether in wartime Laos or in American emergency rooms. But whatever the stakes and wherever the setting, Fadiman's reporting is meticulous, and her prose is a delight. From start to finish, a truly impressive achievement."—Michael Bérubé, author of Life As We Know It

"When a Hmong child and her parents encounter the American medical system, what takes place is a veritable explosion that reveals the weaknesses and rigidity of both systems. Ms. Fadiman's painstaking research and extraordinary writing skills make this into a compelling story that, once started, cannot be put down. And yet The Spirit Catches You and You Fall Down is also a unique anthropological study of our society, one that will endure and be referred to for years to come."—Abraham Verghese, author of My Own Country

"So extraordinary is this tale, no conventional label comes to mind. It is a story of the tragedy of an ill child, a debate between two improbably clashing cultures, an essay on the limits of reason and authority. Anne Fadiman has yoked all three forms into a remarkable book which touches on every aspect of human capability and makes one feel at once more and less in control of life. This is a beautiful and haunting piece of work."—Roger Rosenblatt

"Some writers . . . have done exceedingly well at taking in one or another human scene, then conveying it to others—James Agee, for instance . . . and George Orwell . . . It is in such company that Anne Fadiman's writing belongs."—Robert Coles, Commonweal

"In The Spirit Catches You and You Fall Down, Anne Fadiman tells the story of a Hmong family's experience with the American health care system and highlights many of the weaknesses of what some describe as the best health care system in the world . . .  It will also attract readers interested in the dynamics of power in the doctor-patient relationship and readers who can find inspiration in one family's devotion to a chronically ill child. Nao Kao and Foua Lee and their children came to the United States because they felt they had no other option. They could not return to their home in Laos because there they faced persecution, yet they had to leave their refugee camp in Thailand because it had been scheduled to close. They settled in a Hmong community in California, where their daughter Lia was born. The treatment of Lia's seizure disorder in the United States, both by her parents and by her health care providers, is the theme of this story . . . We learn, for example, that long before the Lees even considered coming to the United States they had heard rumors about American doctors: doctors casually take blood from people, including children (the Hmong believe that the body contains a finite amount of blood that is not replaceable); doctors remove organs from their patients to eat or sell for food; doctors anesthetize patients and in so doing put their patients' souls at large, leading to illness or death; and when Hmong are admitted to the hospital, doctors cut the 'spirit-strings' from their wrists, thus disturbing their 'life-souls.' American doctors, in turn, often consider the Hmong to be ignorant, backward, and too reliant on animal sacrifices and other unacceptable practices. During Lia's treatment, the assumptions and beliefs that both parties brought to the patient-doctor interaction were never adequately explored. Doctors often took advantage of their powerful position, and along the way there was a lack of trust and respect between the family and the doctors. Much of Fadiman's book explores how each party blamed the other for the tragic outcome—Lia's severe mental and physical disabilities. In one of the book's final chapters, Fadiman suggests ways in which health care providers can improve their ability to care for patients whose background is different from their own. The chapter draws heavily on work by Arthur Kleinman and others who began exploring cross-cultural medicine before it became popular. Readers of Fadiman's book will understand, however, that to provide high-quality, appropriate care for the diverse populations using the U.S. health care system, health care providers and organizations must adequately assess the need for resources to address a wide range of cross-cultural issues. Holding a 'diversity' or 'multicultural' day in a hospital or medical school is a superficial and inadequate approach. More meaningful is participation by bilingual, bicultural, professionally trained interpreters, the lack of which played a major part in the miscommunication between the Lees and their physicians. Americans' lack of understanding of the hierarchy in the Hmong community and of how conflicts are resolved was also a major barrier that might have been addressed by a health worker representing the Hmong community. The Spirit Catches You illustrates how much time, energy, and commitment are necessary to understand another culture's perspective on health and wellness and to translate that understanding into the day-to-day practice of medicine."—JudyAnn Bigby, M.D., Journal of the American Medical Association

"Compellingly written, from the heart and from the trenches. I couldn't wait to finish it, then reread it and ponder it again. It is a powerful case study of a medical tragedy."—David H. Mark, Journal of the American Medical Association

"A vivid, deeply felt, and meticulously researched account of the disastrous encounter between two disparate cultures: Western medicine and Eastern spirituality, in this case, of Hmong immigrants from Laos. Fadiman, a columnist for Civilization and the new editor of the American Scholar, met the Lees, a Hmong refugee family in Merced, Calif., in 1988, when their daughter Lia was already seven years old and, in the eyes of her American doctors, brain dead. In the Lees' view, Lia's soul had fled her body and become lost. At age three months Lia had had her first epileptic seizure—as the Lees put it, 'the spirit catches you and you fall down.' Lia's treatment was complex—her anticonvulsant prescriptions changed 23 times in four years—and the Lees were sure the medicines were bad for their daughter. Believing that the family's failure to comply with his instructions constituted child abuse, Lia's doctor had her placed in foster care. A few months after returning home, Lia was hospitalized with a massive seizure that effectively destroyed her brain. With death believed to be imminent, the Lees were permitted to take her home. Two years later, Fadiman found Lia being lovingly cared for by her parents. Still hoping to reunite her soul with her body, they arranged for a Hmong shaman to perform a healing ceremony featuring the sacrifice of a live pig in their apartment. Into this heart-wrenching story, Fadiman weaves an account of Hmong history from ancient times to the present, including their work for the CIA in Laos and their resettlement in the U.S., their culture, spiritual beliefs, ethics, and etiquette. While Fadiman is keenly aware of the frustrations of doctors striving to provide medical care to those with such a radically different worldview, she urges that physicians at least acknowledge their patients' realities. A brilliant study in cross-cultural medicine."—Kirkus Reviews

"A compelling anthropological study. The Hmong people in America are mainly refugee families who supported the CIA militaristic efforts in Laos. They are a clannish group with a firmly established culture that combines issues of health care with a deep spirituality that may be deemed primitive by Western standards. In Merced, CA, which has a large Hmong community, Lia Lee was born, the 13th child in a family coping with their plunge into a modern and mechanized way of life. The child suffered an initial seizure at the age of three months. Her family attributed it to the slamming of the front door by an older sister. They felt the fright had caused the baby's soul to flee her body and become lost to a malignant spirit. The report of the family's attempts to cure Lia through shamanistic intervention and the home sacrifices of pigs and chickens is balanced by the intervention of the medical community that insisted upon the removal of the child from deeply loving parents with disastrous results. This compassionate and understanding account fairly represents the positions of all the parties involved. The suspense of the child's precarious health, the understanding characterization of the parents and doctors, and especially the insights into Hmong culture make this a very worthwhile read."—School Library Journal

"When two divergent cultures collide, unbridgable gaps of language, religion, social customs may remain between them. This poignant account of the clash between a Hmong family and the American medical community reveals that among the gaps yawns the attitude toward medicine and healing. The story focuses on Lia Lee, whose family immigrated to Merced, Calif., from Laos in 1980. At three months of age, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, 'the spirit catches you and you fall down.' Fadiman traces the treatments for Lia's illness, observing the sharp differences between Eastern and Western healing methods. Whereas the doctors prescribed Depakene and Valium to control her seizures, Lia's family believed that her soul was lost but could be found by sacrificing animals and hiring shamans to intervene. While some of Lia's doctors attempted to understand the Hmong beliefs, many interpreted the cultural difference as ignorance on the part of Lia's parents. Fadiman shows how the American ideal of assimilation was challenged by a headstrong Hmong ethnicity. She discloses the unilateralness of Western medicine, and divulges its potential failings. In Lia's case, the two cultures never melded and, after a massive seizure, she was declared brain dead. This book is a moving cautionary tale about the importance of practicing 'cross-cultural medicine,' and of acknowledging, without condemning, differences in medical attitudes of various cultures."—Publishers Weekly