The Spirit Catches you and you fall Down
Theory | Methodology | Data Analysis | Conclusions
In The Spirit Catches you and you fall Down, Anne Fadiman presents the drama behind a clash of epistemologies. In an interpretive sense, the story might be considered a treatise on cultural relativism. Fadiman encapsulates the Hmong way of life in the United States as it is ensnared by western medical epistemology. Both the hopes and fears of the Hmong refugees in Merced, California, are played out in compelling narrative as Lia, the youngest child of Foua and Nao Kao Lee, is treated by western doctors at the Merced Community Medical Center for epilepsy, translated in the Hmong language as the spirit catches you and you fall down.
The history of the Hmong yields several lessons that anyone who deals with them might do well to remember. Among the most obvious of these are that the Hmong do not like to take orders; that they do not like to lose; that they would rather flee, fight, or die than surrender; that they are not intimidated by being outnumbered; that they are rarely persuaded that the customs of other cultures, even those more powerful than their own, are superior; and that they are capable of getting very angry. Whether you find these traits infuriating or admirable depends largely on whether or not you are trying to make a Hmong do something he or she would prefer not to do. Those who have tried to defeat, deceive, govern, regulate, constrain, assimilate, intimidate, or patronize the Hmong have, as a rule, dislike them intensely (p. 17).
When she was three months old, Lia Lee’s older sister slammed the front door of their Merced apartment. Lia’s eyes rolled up, her arms jerked over her head, and she fainted. The Lee’s knew the loud noise had frightened her soul and that it had fled from her body and become lost. They recognized this as quag dab peg, “the spirit catches you and you fall down.” Generally translated in Hmong-English dictionaries, quag dab peg meant Lia had epilepsy.
Lia was born on July 19, 1982 at Merced Community Medical Center. Her first seizure occurred on October 24, 1982. Lia’s parents refused to take her to the hospital until they were certain it was a dire emergency. Their fear of American hospitals and doctors went back to their days in a refugee camp in Thailand where they learned to fear American doctors. Some of their questions of leaders in the refugee camp included: Why do American doctors eat the livers, kidneys, and brains of Hmong patients? Is it true that when Hmong people die in the United States, they are cut into tiny pieces and put in tin cans and sold as food?
It wasn’t until Lia’s third visit to the hospital emergency room on March 3, 1983 that her epilepsy was correctly diagnosed. Over the course of the next few years, Lia visited the hospital many times. She became easily recognizable by the staff at MCMC (Merced Community Medical Center). The primary physicians to care for her were Dr. Neil Ernst and Dr. Peggy Philip. During the course of their treatment, various combinations of drugs were tried to help control Lia’s seizures. Cultural barriers and basic misunderstandings prevented Lia from getting correct dosages of prescribed medication, so doctors were never sure if she was getting the right amounts and combinations of her medicine. When Lia’s parents didn’t comply with medical instruction to medicate Lia, they were doing so partly out of ignorance of how to administer the complicated combination of dosages and partly out of the belief that the medicines were not making Lia better but were possibly making her worse. “…If [doctors] continue to press their patients to comply with a regimen that, from the Hmong vantage, is potentially harmful, they may find themselves, to their horror, running up against that stubborn strain in the Hmong character which for thousands of yeas has preferred death to surrender” (p. 51). At one point, Lia was taken out of her parents’ custody and placed in a foster home to ensure she would be properly medicated. Her seizures didn’t stop.
On November 25, 1986, Lia had “the big one.” It was her sixteenth admission to MCMC. She continuously seized for nearly two hours. When she stopped, she was unconscious, but breathing. She was sent by ambulance to Valley Children’s Hospital in Fresno, where she could receive better care in the Pediatric Intensive Care Unit. Lia was eventually released from VCH into her parents’ care with instructions to give a single medication with simple dosages. Doctors didn’t expect Lia to live more than a few hours or days. She lived for years.
The problem that arose between Lia’s parents and doctors regarding her care was more than a language barrier; it was a cultural barrier. The Hmong view of healthcare is precisely opposite of the prevailing American view. Western medicine is viewed as being very scientific and specialized. The Hmong preoccupation with medical issues is essentially a preoccupation with life, death and life after death. When a Hmong patient complains of stomach pains, he/she is actually complaining that the entire universe is out of balance. For a Hmong, medicine is religion, religion is society, and society is medicine. The main problem is that medical schools don’t teach doctors that diseases are caused by fugitive souls and cured by sacrificial animal shamanism. It is not uncommon for Hmong patients to remain passively obedient to all their doctor’s instructions. By doing so, they protect their own dignity by concealing their ignorance about the doctors explanations and instructions while protecting their doctor’s dignity by acting deferential. Then, as soon as they leave the hospital, they ignore everything to which they have agreed. Doctors soon learn that “yes” simply means that the patient is politely listening, not that they are agreeing with or have any idea what the doctor is saying.