Book Review: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Anne Fadiman, the author and narrator of The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Culture, shares the story of Lia Lee, a young Hmong girl with severe epilepsy, to demonstrate the detrimental impact of cultural misunderstanding between families and their doctors. This book alternates with one chapter focusing on Lia’s story and the next educating the reader on Hmong traditions and culture. Fadiman supports her argument by countlessly comparing traditional Hmong healing practices with American medicine, emphasizing the gap between the two and the need for improvement.

Fadiman’s story is targeted at culturally uninformed interdisciplinary members. She foils Lia’s doctors Neil Ernst and Peggy Philp with Jeanine Hilt, Lia’s social worker who is an “incredible patient advocate” (p. 114) for the Lee’s. When the Lee’s first bring Lia to the emergency room for her seizures, the hospital staff is unable to communicate with Foua and Nao Kao about their daughter’s illness. This miscommunication continues with each hospital visit. The lack of translators and individuals educated on Hmong traditions force the American doctors, hospital staff, and social services to view the Lee’s as uncooperative and noncompliant. With the growing Hmong community in Merced, California, the American doctors and hospital staff would have benefitted from learning about the Hmong culture, as this would allow them to understand how and why the Lee’s made some of their questionable decisions regarding Lia’s treatment. The tone expressed by Fadiman is objective and solemn; this allows both the Lee’s and the health professionals involved in Lia’s treatment to rationalize their annoyance, irritation, and frustration with each other to the reader. When Lia experiences her most severe seizure, she suffers brain damage. This tragedy ultimately brings the two parties closer, although it is too late. The closing of the book, aspiringly, fills the reader with hope.

Lia’s brain damage could have been preventable by removing cultural barriers and improving collaboration between families and interdisciplinary teams. Fadiman clearly argues that a mix of traditional healing with western medicine is ideal. She mentions a program called “Bridging the Gap,” which is a cross-cultural education program to train hospital staff to be culturally mindful of patients. The television segment on the Hmong cable channel regarding American hospitals and treatment was another attempt to reduce the cultural miscommunication in Merced. The Nationalities Service of Central California received a grant to integrate western mental health with traditional Hmong practices, and this was an outstanding success. The interaction between doctors and spiritual healers indicated that the interaction between these fields boosted patient morale.

Doctors alone are not enough to cure a patient, especially when culture is the barrier. Fadiman countlessly brings up the sad fact that Lia’s brain damage could have been prevented by communication and strengthened interactions between the doctors and hospital workers, social workers, translators, spiritual healers, and patients. This emotionally captivating book will motivate the reader from any background for advocating cultural awareness among interdisciplinary teams.


Review by: Shannon Sim, Concordia University of Edmonton

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
Anne Fadiman
New York: Noonday Press, 1998
341 pages, CA$12.29
ISBN 0374525641 9780374525644