In the book, The Spirit Catches You and You Fall Down, Anne Fadiman tells us the story of a little girl named Lia Lee, caught between the differences of two cultures. The differences in Lia’s parents’ knowledge, abilities, and understanding of the culture they were surrounded by and the rationalized facts that Western medicine and its culture provide bring us to the borderland of the two. When these two cultures meet Lia’s life is put in danger, not only by epilepsy and septic shock, but also by the conflicts between her parents and doctors.
Lia’s life depended on the realities of the two cultures to act together in harmony to bring her health and happiness. The mutual misunderstanding of the two failed to bring help to her wellbeing. This quote by Fadiman, “I have come to believe that her life was not ruined by septic shock or noncompliant parents but by cross-cultural misunderstanding” (262) which shows us that while Lia was harmed by a physical disease, she was also harmed by a cultural disease or that which resulted in the conflicts between the two.
Some of the conflicts between the cultures were the language barriers, prejudices of culture, and religious conflicts. The language barrier was a serious conflict that led to the inability of asking simple questions such as “Where do you hurt? ” This led to the misdiagnosis many times for Lia. This language barrier also proved harmful to Lia’s wellbeing when she was finally correctly diagnosed and drugs were given. Lia’s parents had no way to be able to be even minutely successful in the administering of these drugs which led to the terrible injustice of Lia being taken away from her parents.
The medical professionals in this story were an interesting blend of misunderstanding and incredible empathy. For example, Neil Ernst and Peggy Philp take an interesting stance on this patient’s case. While they may have been more understanding than some of the doctors, or at least open to the understanding, they never were able to grasp the soul concept of the Hmong. These doctors had strong discrepancy in both appreciation and perception of the Hmong who believed that the soul healed illnesses. Dan Murphy was another doctor that was a part of Lia’s case.
Murphy was the doctor that was on duty when Lia was brought into the emergency room at Merced Community Medical Center. He was very interested in Lia’s culture and knew quite a lot about the Hmong. Jeanine Hilt, though she was not technically a doctor, her role as Lia’s social worker showed a complete opposite of Ernst and Philp. Where Ernst and Philp were unable to understand the Hmong culture, Hilt made the Hmong culture and Lia herself her personal cause. Hilt shows that she truly cares for both of them by fighting MCMC in the ways that she can.
These doctors and others played an important role in Lia’s story. Their viewpoints, however, vary in origin so greatly that it’s hard to see which doctor would have cared better for Lia and each of their actions lead to many different reactions from the reader. I had many different reactions to the choices and decisions made in this book. One of the choices I reacted to the most was when Dr. Ernst was frustrated with the Lees, so he reported them for child abuse because they were unable to correctly administer the medication that Lia needed.
Also, the Lee’s feelings on the subject seemed to be pushed aside for the better of Lia but Lia would have been better served if her parents understood what was happening to their beloved daughter. This choice by Dr. Ernst led to Lia being taken from her loving parents. I was angry and frustrated with the doctor’s inability to see both sides of the situation and search for the best situation for Lia. The fact that he could have completely prevented Lia from being taken from her home makes me sad and extremely worried for our health system.
The Lee’s decision to not take Lia in until it was a dire emergency I can somewhat relate to. My parents don’t love doctors and hospital so unless necessary, our family usually uses homeopathic methods of healing but at the same time it’s hard to compare a flu and epilepsy. The fact that the Hmong have a completely different understanding of how sickness is caused compared to the doctors of Western medicine leads to all of Lia’s problems. The Hmong believe that sickness is caused by a malevolent spirit that steals a person’s soul. The lost soul can only be returned to the body by a ritual performed by a shaman.
Western medicine is viewed as scientific and specialized in different areas of anatomy, physiology, and pathology. These differences led to the misunderstandings so prevalent in this story of Lia. The misunderstandings led to the stubborn will of loving parents trying to protect their daughter and keep her safe and this will and the beliefs of Lia’s parents strongly contradicted everything that Western medicine is based in. This theme of difference is what the author uses to show that while Lia’s medical problems were, well, problems, she shows us that her condition aggravated by the cultural conflict.
My overall opinion of the book is that I wasn’t as entertained or inspired as I would have liked to be. Lia’s story left me sad and questioning the medical system in America and the way that we view other cultures. The differences that both sides could not overcome left me with a bitter taste in my mouth and a little bit more cynicism in my heart. I wouldn’t recommend this book to others but I can see the merit of why medical students or those looking into the medical field would need to see this side of the medical world.
