¶ … Spirit Catches You and You Fall Down I believe Anne Fadiman was trying to prove that it is possible to work through tough cultural barriers by showing the mistakes of Lia Lee's doctors. By showing these examples, and also giving examples of how culture can work together, Fadiman is trying to prove that the American medical system needs to have other socially accepted avenues of therapy to work alongside of conventional medicine. The health issues faced by the Hmong Lee family, both from patient's point-of-view and the family's point-of-view are affected by their adaptation to the United States and their feelings toward health care and health care providers. It is hard to know what Lia Lee thought of her epilepsy since the audience never hears her voice an opinion on the matter. It is crystal clear, however, what the Lee family thought the health issue was: quag dab peg, roughly translated in English means "The spirit catches you and you fall down." Essentially, Lia's parents felt that her spirit was startled by a slamming door, it then briefly left her body, which was then snatched by an evil spirit; startled her spirit and then she "fell down" into an epileptic edpisode.

In several instances throughout the book, the author narrates the fear and confusion towards Western medicine. In refugee camps throughout Thailand, Hmong tribes readily believe that American doctors take too much blood from patients (believed to cause death among Hmong tribes), after you die doctors take out the brains, and that when Hmong people die they are cut up into small pieces and put into tin cans to be sold as food. Hmong are so suspicious of American healthcare because their own shaman, or medicine men, do not touch those they care for, do not cut into them, do not examine people while naked, and do not heal those of the opposite sex from themselves. In fact, most of the routine medical procedures, examinations, medications and surgeries performed by Western doctors are most definitely viewed as harmful or threatening to Hmong; which is why such stout resistance is met by nurses and doctors when anything needs to be done to the patient.

Hmong are a very stubborn people, who value family above all else, and who demand that outsiders earn respect before it is given to them. The reason for this is that Hmong people have never actually had their own country to do what they wanted and practice their beliefs as they wanted. It seems that they are always fighting with someone just to be left alone, and in the end, the only support they had was from their own families and tribes. This is why whenever important decisions must be made; all members of the family are included in the decision-making. Everyone is important, and no one is left behind. This feeling of family definitely contributes to the motivations for not giving Lia her medication as prescribed. As someone who readily second guesses my doctor's opinion, and will question what that recommendation means for me personally, I definitely see where the Lee family was coming from. However, the situation was fraught with difficulties from the beginning because Lia was a child, and it seemed that both sides of Lia were blinded to her best interests by this fact. Parents are always hyperprotective of their children, and doctors are put under stress because they are legally bound to not mess up and make a mistake with children especially. However, there was also the fact that the Lee's were experiencing firsthand the side effects of the medication, and the huge language barrier (the Lee's could not read English) was further confusing them. Almost the whole time, even with an interpreter, they did not know what to give her and when because the medicines and schedules kept changing, they did not understand what it was supposed to do or understand the dosages because there is no Hmong interpretation for Western medical terms (or measurements or clock times). It was just a very difficult situation that seemed to be getting worse in the eyes of the Lee family.

As far as the numerous healthcare providers that the Lee family saw for Lia, I wholeheartedly disagree with how they treated the family. Instead of being culturally sensitive, and maybe doing some research and background reading, they decided to act like typical Americans where they felt...

Of course they are not going to get through to the family if that's the way they act! Fadiman had examples of other cases where social workers or doctors deferred to their interpreters for a proper ways to speak with the family, facilitate understanding, and maneuver through cultural misunderstandings. Lia's doctors did not do any of this, even when they did have interpreters available. I believe the providers mostly saw the Lee family as stubborn and stupid, which is a completely false statement. What is sad, is that in the interviews and accounts with the doctor's who mainly worked with Lia's case, even after explanations of their beliefs, it is clear they the doctors still don't understand what they needed to work through and do properly. They admit to maybe being more open minded, but it is much more than that. No one bothered to ask the Lee family what they think happened, or what caused her illness or what the family would prefer they do about it. They made executive decisions based on some really awful assumptions they made about the family, making a very bad impression for the Lee's which set them up for immediate mistrust, effectively closing down communications.
Fadiman's book has a story about how there is a Hmong folktale about how Shee Yee fought with nine evil dab (evil spirit) brothers which reflects Hmong culture. The tale is about how Shee Yee had the will and spirit, and cunning, to transform himself into anything needed to defeat the brothers and go home to his family. In many ways, the Hmong culture is the same, where they are so strong and so supportive of one another that nothing can bring them down, they will adapt. So many experiences and events seem horrible to us when Americans read about them, we often think "I would never be able to go through that and live." But, for the Hmong, the past is the past, you live it, you adapt, and you move on. To the Lee's it was the same, Lia had a horrible illness, but they didn't think it was the worst thing in the world, so they accepted it and moved on. This type of culture can be equated to an attitude as well, where an American doctor can learn from a shaman, and a shaman can learn from an American doctor. American doctors need to learn to include the spirit with the body, and realize that they really do belong together. In an example in the book, an American doctor allows a shaman to perform a ceremony on a man's gallbladder area, to remove the pain. When this ceremony fails to remove the pain the patient then believes it's not a spiritual problem and consents for surgery recommended by his physician, which is a success: pain free. It is the same with a conventional doctor telling a patient they have cancer with six months to live, when that same patient goes to a highly recommended cancer treatment center, which has positive attitudes and tries all different methods for treatment, suddenly it's four years later and the patient is cancer free.

Shamans call it the spirit, Americans call it the soul, psychologists call it the mind; whatever it's called, people do have a life force within them and it must be considered in medicine. Conversely, shamans might be interested in learning rudimentary medicine, such as that humans have organs like animals do, drawing blood will not kill a person, and maybe a beginning medical class or two will help to expand their knowledge of the physical body. It also might be helpful for them to learn how American medicine works so that they can properly explain to family members what is really trying to be accomplished with a doctors recommendations. Perhaps they could come up with Hmong language expressions and alternatives to explain medical terms used.

In the book, a terrible event happens for the Lee family, where Lia is sent to foster care because the Lee family has been deemed unfit to care for her due to the fact that they keep messing up her medication. Through several interviews that Fadiman conducted, it was clear to many people who knew about the Lee family and Lia that this was not a proper course of action signed for by their doctor. However, the foster parents that she was ultimately sent to for a better part of a year, turned out to really be affectionate and loving for Lia. They knew right away that this was not a good…