May 12, 2010
Book Review: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman
The Spirit Catches You and You Fall Down, by Anne Fadiman, gets its title from a direct translation of the Hmong phrase qaug dab peg, which succinctly summarizes the Hmong belief that a person living with epilepsy is not suffering from overactive synchronous neuronal functions but instead from an invasive, evil spirit that induces the seizing. Fadiman gives a real-life account of two Hmong parents and their epileptic daughter Lia Lee, who, with her fourteen-person family, experiences firsthand the collision of Eastern and Western medicine while simultaneously taking part in the mass Hmong fleeing from Communist party’s 1975 takeover of Laos.
The narrative begins in a small hospital in California, the site of Lia’s birth – the first of twelve births in the family to take place in a hospital. The immediate friction between Eastern and Western medicine – for example, that Lia’s placenta is disposed of, preventing its burial in the floorboards of the family’s home -- serves as a the first taste of what becomes an almost impossible reconciliation between two diverging cultures because of their drastically differing modes of communication, inherited beliefs and understandings of medicine, and even politics.
Because of such miscommunications and insistence on the part of Lia’s family to maintain what they recognized as appropriate spiritual measures to take for the epilepsy (and refusal to accept treatment normally relied-upon by Western medicine), Lia’s seizures quickly became more drawn out and serious. One doctor reflects on the harrowing period of time spent “waiting” for the end to come for Lia:
It was hard to imagine that the Lia era would be over, but I remember thinking it was going to be. We were just waiting for the big one. It was so haunting… I would be the one on call, and I couldn’t stop it and she was going to die right before my eyes. (118)
The interactions between Hmong and American then, become extremely strained, “one-sided, with the Westerners holding all the knowledge, [and that] what the medical establishment was offering would continue to be rejected since the Hmong would view it not as a gift, but as a form of coercion” (37). The interactions between doctor and patient become a sort of bartering, of agreement on the lowest of the lowest common denominator.
Fascinating in these ideological discrepancies are the explanations of epilepsy as defined by Eastern and Western medicine. Of the Hmong’s general understanding of seizing – what she translates as “soul-stealing,” Fadiman writes:
Lia’s eyes rolled up, her arms jerked all over her head, and she fainted. The Lees had little doubt what happened. Despite the careful installation of Lia’s soul during the hu plog ceremony, the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. (20)
The real beauty of this book is that Fadiman exposes the benevolent intention behind this sort of shamanistic belief that is, of course, not contained to epileptic episodes. Fadiman uses Lia’s situation to call attention to the peculiar, but really incredible notion that to be born with epilepsy is a true honor given for healing purposes; it is a gift that must be used in order to help those suffering from physical and mental illness.
In line with the fear of the human soul’s escape from the body comes a refusal of invasive medical interventions. Surgery, for instance, have the potential to release the human soul, and so is frowned upon by the Hmong who, in their refusal of this sort of ordinary American medical practice, risk losing lives. It seems to be a risk they are willing to take, and that, perhaps above all, is fascinating to me. It is also the place that ties into our neurobiology course, more than the epileptic brain functions I originally sought after as the linking material for this assignment.
What I have found so relevant is less aligned with the content of our course but rather with the philosophical foundation upon which the course was carefully built. Above all, The Spirit Catches You and You Fall Down brings relativity, experience, and, by extension, individual context into our rather funny need to sort out what is “right” and “wrong” in our lives. Just as we must ask questions without strict definitions of terms, so must Lia’s American doctors understand that her family’s cultural experiences are so incomparable to their own that to forge a “correct” discourse would be disingenuous, nonsensical, and unproductive. Instead, we must reevaluate the question that seemed so strange in class: “do we all live in the same universe?” and, with a resounding Yes, but … no, continue our lives in a way that is both fitting with our understanding of what is most important in life, allowing ourselves to be taught by others in and out of academic settings, and helping to build others’ understanding of their own universes, and ours, along the way.
 This Hmong tradition exists so that after death, the spirit can find its way back home to the site of the placenta.