Challenges of Among Refugees in 'The Spirit Catches You and You Fall Down'

'The Spirit Catches You and You Fall Down' essay was written by Anne Fadiman. This story explains the hardships faced by Hmong refugees after migration to the United States from Laos, and in particular we are introduced to the characters of Foua Yang and Nao Kao Lee who fled from Thailand in 1979 while trying to escape communist rule and persecution. Most notably, Fadiman analyzes and describes the complexity and difficulty of trying to integrate two different cultures causing a cultural divide between the Hmong and the American medical system. 'The Spirit Catches You and You Fall Down' bookr can show the importance of building a trustworthy relationship when working with clients in a social work environment.

In Fadiman' narration, the book outlines some very depressing and unique situations while all the characters in the book are very real and relatable. In the Hmong culture, and typically other Asians cultures, their medical heritage is very old and laterally connects to their religious beliefs; this cultural manner was one of the many challenges which were involved in their blending into the American lifestyle and culture. Throughout the chapters, Fadiman highlights the many different struggles and hardships the Hmong people endured through the story of Lia Lee, a young Hmong girl, the daughter of Foua Yang and Nao Kao Lee, who was diagnosed with epilepsy.

Lia was the last born child out of fourteen children and the first child to be born in an American hospital - Merced Community Medical Center (MCMC). Her mother, Foua, had birthed all of Lia’s thirteen brothers and sisters back in Laos. Three months after she was born, Lia began having frequent violent seizures. At the age of four, a sceptic shock eventually caused her to become mentally retarted and non-responsive. Describing her character, her foster mother Dee Korda described her as “one of the most affectionate kids she's ever cared for.” Lia was loving, an affectionate child who was exceedingly affected by the side effects of the medicine she had to take for her condition. She was spoiled by her parents and they gave her what she wanted when she wanted it. Her family continued to show love and support towards her and did not stop caring for her even in her vegetative state for over twenty-five years. Against all odds, though, Lia continued to live, even without any form of life support.

Because of Lia’s condition, her cultural values and norms were not as outlined as her parents’ were. Lia’s family’s cultural identity lays out the distinct ways in which people adhere to “various strongly-held beliefs and doctrines set forth by their cultures.” The Hmong culture base their practice on spirituality and even with Lia’s epilepsy, her parents considered the practice of medicine and her sickness to be closely related to the divine in spirituality. Fadiman in many instances evokes the Hmong history to highlight the details and events of Lia Lee’s medical turn of events. Fadiman addresses the history and context of the Hmong ethnic identity in several different chapters, which she identifies as “independent, insular, antiauthoritarian, suspicious, stubborn, proud, choleric, energetic, vehement, loquacious, humorous, hospitable, generous.” This is a characterization that she gathered from tracing the Hmong back to 2700 B.C., when they denied Communist rule from the Chinese. From that time, she argues, they have been resisting to submit to any form of rule that might compromise their traditions and ways of life particularly in Lia’s case, explaining and justifying why Nao Kao and Foua refused to conform and accept Neil and Peggy’s treatment plan for Lia as “agreeing with their medical theories would have contradicted their own beliefs.” Within the same culture, all Hmong people are not the same, Fadiman outlined culturally significant historical landmarks to give readers a framework for understanding the beliefs and making sense of the decisions made by the Lee family and other Hmongs—beliefs that might otherwise seem incomprehensible and lead to bigotry. Fadiman also outlined the cultural significance of Hmong folktales and myths, as many of them summarize the attitudes and behaviors of the Lee family that American doctors like Neil and Peggy found so difficult to comprehend. As the book concludes, we come to the realization that the Lee family’s cultural practices and actions were not “blind stubbornness nor disregard for Lia” but they were simply doing what they saw fit for their daughter’s health according to their cultural beliefs and norms.

Because of her sickness, Lia did not have the freedom of human development. She fell sick at a very young age and lived in a vegetative state for twenty-six years out of the thirty years she survived. Her condition denied her the choice of who to be, what to do, and how to live. She did not have the privilege to attend school and get an education as this opportunity ceased after she suffered her first seizure at the age of three months. This epilepsy defined the structure of her thirty year life span. On the contrary, giving credit to my parents and surrounding adults in my family, I have had the opportunity to live a very healthy lifestyle to this date. From an infancy stage through development to now being an adult, I have constantly been able-bodied without any type or form of mental or physical disability. I have had the opportunity to start and complete all levels of education: primary, secondary and tertiary level, giving me access to higher paying careers in the future.

My ethics and cultural beliefs as an African are similar to those of the Hmong culture in terms of the strength of family. African families tend to be large with an average of about five children per family. Lia had thirteen brothers and sisters. In terms of religion, I am of Christian faith. I believe in a God that eternally exists in three persons: God the Father, God the Son, and God the Holy Spirit. I believe that the human body takes on three basic elements: the flesh which is the physical component of my being, the soul animates the body and lives within the flesh, and the spirit which allows us to communicate with the spiritual realm and communicate with God. The Hmong however, follow the Buddhism faith. Through the animism tradition, believes that “spirits live in a different realm and are independent of the physical bodies.” They believe that a person has twelve souls. This soul is different from the spiritual world as it dwells in the physical world unlike the spirits. They strongly believe in the presence of the supernatural.

The challenges that I would face in confronting my own biases about the Hmong culture and having Lia as my client would definitely pertain to religion. Christianity is a very dominant religion practiced all over the world so embracing the Hmong culture of a shamanic culture through a neeb healing ceremony to try to return Lia’s soul would have been extremely challenging, especially because Lia herself in the beginning when the family sacrificed Lia’s pig was skeptical about the process until she was under the xiv neeb spell. The difference in religion practices could deter me from feeling and expressing genuine empathy to Lia and her family during this challenging experience. Because Lia was so young when she initially fell sick, she had no ability to express her concerns, desires and opinions. The communication barrier with Nao Kao and Foua Lee would have been a hindrance of progress between us because evidently the book showed that even if I have good intentions for Lia as a client, language misunderstandings could have lifelong implications and devastating consequences.

Overall the medical providers in this book appeared to be either frustrated or too busy to develop trust in the patient. If they would have taken the time to build that relationship with Lia and her family, a better outcome and smoother intervention would have been accomplished because Lia’s epilepsy could have been detected at an earlier stage. With the continuing evolvement of globalization, the medical facilities need to emphasize the importance of a higher level of understanding of how cultural boundaries affect the healthcare system. Illustrated by Lia’s turn of events throughout the chapters, healthcare cannot be executed in a vacuum without communication and understanding between patients, physicians, and the patient’s families. It is an essential process of medical care, as it necessitates a healing of a patient’s entire well being.