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The ethnography I have chosen to review for this critical review essay is titled “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures” by Anne Fadiman. Released in 1997 the book brings to light the hardships of the Lee’s a Hmong refugee family originally from Laos and the California healthcare system that they have to navigate through to help their daughter Lia who has a severe form of epilepsy. The way in which the book is written is one that is particularly unique as the chapters alternate between the story of Lia and her struggle to then discussing Hmong social customs and history. The main thesis or theme brought up in the text is the idea of cultural collision, in the book the culture and thinking of Western ideals and medicine conflict with those of the Hmong people and in this specific case Lia Lee and her family.
The opening five chapters to “The Spirit Catches You and You Fall Down” set up the story and main theme of the text. In the first chapter Lia is introduced having just been born. In the chapter Fadiman introduces Foua, the mother of the Lee family. The author then goes into detail on the customs and traditions that are practiced by the Hmong people when giving birth and afterward. She then explains Lia’s birth in California in comparison to the way the mother had given birth previously in Laos with their customs and beliefs. The second chapter titled is the first chapter completely devoted to discussing the Hmong people and their history, culture and customs. This particular chapter focuses on the history of the Hmong and the persecution and violence that has been directed towards them for a majority of their existence, with most of the conflicts occurring in China. The third chapter which is named after the title of the book brings to light Lia’s severe epilepsy and the way her family handled it initially. The chapter also goes on to mention the first couple of times the Lee family brought Lia to the hospital for her epilepsy, with mixed results. The fourth chapter is the second chapter devoted to discussing the culture of the Hmong people. This particular chapter talks about the Hmong’s distrust of Western medicine. With particular taboos surrounding some of the practices that Western doctors seem to practice. The fifth chapter returns back to the original storyline of the Lees and Lia, with this chapter talking about her childhood and her constant time in and out of medical facilities, while also introducing Neil Ernst and Peggy Philp as Lia’s pediatricians. Lia is then given strict medication but her parents do not comply with her medicine, resulting in Lia suffering a severe seizure leaving her unable to breathe for an entire day because of it. Eventually, Neil contacts Child Protective Services, in the hope that this will save Lia and put her back on the medication.
The next five chapters continue building on this theme of cultural collision. In chapter six the author continues to explain the Hmong people and their distrust of Western medicine. Explaining that since their migration from China they’ve encountered diseases once unknown to them. Despite this, they still refused to fully cooperate with medical professionals from the West with their beliefs and customs seemingly clashing with Western medicine. In chapter seven, we go back to Lia, and following Neil’s contact with Child Protective Services Lia is placed in a foster home. Despite being in foster care, it didn’t help and Lia began suffering more and more seizures, causing her developmental disorders to become more severe. In chapter eight the author discusses how she was introduced to the Lees and her prior experience dealing with Hmong people. She later talks about how she herself had to overcome her own cultural biases to truly know and understand the Lee’s. In chapter nine, Lia returns home and despite an initial celebration, the Lees soon realize just how bad Lia had declined mentally because of the seizures. Lia again had another seizure but this time they kept occurring repeatedly, with the doctors and her parents becoming fearful she wouldn’t survive. In chapter ten, we again return to the author discussing the history of the Hmong people in recent times. Including their involvement in the Cold War and their struggle in finding a safe place for their culture and people.
In chapter eleven Lia suffers yet another fit of seizures, these occurring on Thanksgiving Day. Following a CT scan by the doctors it is found that Lia is practically brain dead. Because of this fact, she is taken off of life support and they prepare for her to die naturally. In chapter twelve the author talks about the Lees and their migration story, having tried to escape violence in Laos and with them eventually making it to Thailand and then their eventual immigration to the United States. Fadiman then discusses the mass migration of the Hmong people that occured during and after the War in Vietnam. In chapter thirteen the story of Lia reaches its climax as her parents eventually bring her home despite the wishes of the doctors, so that she may die in peace and at home surrounded by family, she ends of surviving. Chapter fourteen discusses the so called American melting pot using the Lees and their experiences as an example. Chapter fifteen discusses Lia and her life after her massive seizures, being confined to a wheelchair but still alive.
“The Spirit Catches You and You Fall Down” is a unique ethnography and one that tells a narrative and story while also discussing and informing the reader on the unique customs and history behind the Hmong people. There is no main thesis is that is discussed but rather main themes and ideas brought up and built upon as the book unfolds. The main theme of the novel is the cultural collision that occurs throughout the text and it’s a point brought up in a review of the book by New York Times author Richard Bernstein “The family, whose surname is Lee, have a severely epileptic baby daughter, Lia. When the desperately sick baby is taken in hand by the system of Western medicine, two worlds of almost supreme incompatibility collide, with heart-wrenching consequences”. In the review, Bernstein discusses the overarching theme of the novel in addition to also bringing in the author’s own personal beliefs as a way to show some potential bias that could be in the book.
By showing both sides of the coin so to speak in the book, I believe the author is able to be as subjective as possible while also providing the reader with a viewpoint and insight into a culture not everyone has the opportunity to learn about. By showcasing Hmong culture the reader gains an insight into the culture while also showing the conflict that occurs when it comes face to face with Western medicine, which is something a majority of readers are familiar with.
Another theme discussed in the book is cultural compromise. Throughout the book both the doctors and the Lee family have to constantly compromise on issues based on their own set of cultures and ideals. Some of the doctors in the book believed that the Lees cultural difference was nothing more than ignorance, and the Lees distrust the doctors for a majority of the text. In the Publisher Weekly review by Farrar Straus Giroux they discuss this point “This book is a moving cautionary tale about the importance of practicing ”cross-cultural medicine,” and of acknowledging, without condemning, differences in medical attitudes of various cultures. It’s a theme that also builds as the book goes on, with the climax of the book having dire consequences regarding both main themes of the novel.
In conclusion I believe the author supported her main themes very well in this ethnography, with every other chapter incorporating and informing the reader about the Hmong people. With the remaining chapters focusing on how those culture and customs come into conflict with the ideas and practices of Western medicine. With the conflict causing dramatic and heartbreaking events to occur over the course of the Lees storyline in the book. It’s a unique story and a unique perspective on a culture and theme that a lot of people may not think about over the course of their lives. With this book providing people like myself with the opportunity to try to understand cultural collision and how different cultures mix and work either with or against each other.
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