The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures: Anne Fadiman (1997, Afterword 2012, Farrar, Strauss and Giroux.)

By Jen Gilbert

The Multicultural Aged Care library has challenged my long held preference for reading fiction. The shelves hold many intriguing non-fiction titles for someone new to topics related to ageing and cultural and linguistic diversity. One book that has particularly moved me is Anne Fadiman’s 1997 book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.

This book tells the experiences of the Lees, a refugee family from the Hmong ethnic group who resettled in the USA after escaping from communist Laos in the late 1970s. Their youngest daughter, named Lia was born in 1982 in a Californian county hospital. Soon after her birth, it was clear that she suffered from epilepsy.  Fadiman relates the story of the Lee family and their cultural, linguistic, and medical struggles with the American medical system.

Fadiman provides extensive background information on the history, language and culture of the Hmong people. This is not only extremely interesting but also essential in understanding the Hmong response to American mainstream medical thought and practices. The story of the Lee family is supported by extensive research and countless personal interviews ranging from Lia’s treating medical practitioners and social support workers to members of the Hmong community. While her deep affection for the Lee family is never in doubt, Fadiman presents a very balanced and sensitive account of what is was like for everyone involved in Lia’s care. The writing style is very engaging and it is easy to identify with all those involved, with emotions ranging from humour, joy, sadness, anger and frustration.

The Spirit Catches You and You Fall Down won many awards when it was first published in 1997 and I believe these are well deserved. It is also of interest that Fadiman wrote an Afterword for the 2012 edition which gives a welcome update on the Lee family and others, thirty years after Lia was born.

Although the Hmong community in Australia is one of the smallest refugee groups, and you might feel that this book is not relevant to the Australian context, the lessons that we can learn from it are very relevant today. The basic principles of culturally appropriate care, the use of qualified interpreters and a willingness to listen and understand can be easily transferred to working with ageing, ill and frail members of other culturally and linguistically diverse community groups.

In Chapter 17, ‘The Eight Questions’ Fadiman discusses a set of eight questions designed by Arthur Kleinman to find out what a patient understands about their condition. Arthur Kleinman is currently the Esther and Sidney Rabb Professor of medical anthropology and cross-cultural psychiatry at Harvard University. The link below is to an excerpt from Chapter 17, Pages 260-261 in which Fadiman imagines how Lia’s parents would have answered the eight questions “if they had been asked after Lia’s earliest seizures, before any medications had been administered, resisted, or blamed, if they had had a good interpreter and had felt sufficiently at ease to tell the truth”. The answers she suggests provide useful insight into how to develop cultural understanding and sensitivity in the medical/care situation.

Reading this book was a very worthwhile experience and I would recommend it to anyone with an interest in working with CALD community groups.

Further reading:

The Spirit catches you and you fall down at the MAC Library

http://journals.lww.com/academicmedicine/Fulltext/2001/06000/The_Spirit_Catches_You_and_You_Fall_Down__A_Hmong.13.aspx

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