Review of Anne Fadiman’s Book: The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures is a biography book written by Anne Fadiman and published in 1997. The book talks about the conflicts which arise when a Hmong family sends their daughter Lia to Merced Community Medical Center (MCMC) for treatment of her epilepsy. Unable to comprehend the customs and culture of the Hmong society tensions rise between the modern doctors and the traditional Hmong parents.

The first time Lia got sick is when her older sister, Yer, slammed a door shut and a few moments later, Lia’s eyes rolled up; her arms jerked over her head, and then she fainted. Lia’s parents, the Lees recognized her symptoms as a qaug dab peg, which means a spirit catches your soul and you fall down. The spirit is referred to as a dab. A dab is a malevolent soul-stealing spirit. Hence, as a result of the frightening sound of the slammed door, Lia’s soul fled her body and is now lost. When a Hmong dies, its soul becomes a wandering soul; a wandering soul is a soul that must travel from place to place, retracing its life’s path, until it reaches the burial place of its placenta jacket, and puts it on. However, if the soul cannot find its jacket, it is condemned to an eternity of wandering, unclothed, and alone.

In Hmong-English dictionaries, qaug dab peg is generally translated as epilepsy. Qaug dab peg is a well-known illness in the Hmong society and is acknowledged as a serious and potentially dangerous condition. A Merced Congressman named Tony Coelho from 1979 to 1989 is a popular Hmong figure that was known for having epilepsy. A few years ago, some local Hmong men were sufficiently concerned when they learned that Coelho suffered from qaug dab peg. So the Hmong men called the services of a shaman, known as txiv neeb, to perform a ceremony that would retrieve Coelho’s wandering soul.

Hmong epileptics often become shamans because their seizures are thought to be evidence that they have the power to see things other people cannot. As well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen. The fact that they have been ill themselves allows them to sympathize for the suffering of others, therefore, giving them credibility as healers. Becoming a txiv neeb which means a person with a healing spirit, isn’t a choice, it’s a calling. The calling is achieved when a person falls sick, either with qaug dab peg or with another illness whose symptoms similarly include shivering and pain. Therefore, when a person shows these symptoms, they are chosen to be the host of a healing spirit. It’s an offer that the sick person cannot refuse. But there are a few Hmongs who chose to decline the offer. Shamanism is a strenuous calling that requires years of training with a master in order to learn all the ritual techniques and chants. A txiv neeb achieves an enormous amount of social status in the Hmong community as they are considered persons of high moral character. In comparison to a biomedical doctor, doctors study for years to get a medical degree in order to have credibility. Authority is given to a doctor with the coming years as part of the hospital system.

When the Lees took their daughter Lia to the MCMC, Lia had by then stopped seizing. The Lees had no way to explain to the doctor what had happened to Lia due to their lack of medicinal knowledge and most importantly the language barrier. Even though there is usually an interpreter who worked as a janitor in the hospital, but this time he was not there. Lia showed symptoms of a congested chest and coughing when the resident ordered an x-ray for Lia’s chest the radiologist said that Lia had a an early case of Bronchopneumonia or Tracheobronchitis. The resident had no way of knowing that the bronchial congestion was caused by aspiration or the entering of saliva or vomit in to her lungs during her seizure. Lia was dismissed with a prescription of an antibiotic. When Lia was living with her foster family Dee Korda, she followed the anticonvulsant prescription treatment, however, she was still seizing, more than she did when living with her parents. Lia’s doctor Peggy Philp prescribed Lia a series of medications at different times that stops grand mal seizures but they still did not work and at one of those times, Lia suffered a seizure triggered by fever. The doctors had concluded that Lia would not be able to live past a few years due to her continuous cycle of seizures however she had lived much longer than they expected.

Every time Lia had a seizure and came to the emergency room, her two doctors Neil Ernest and Peggy Philp were called in no matter how late it was. The doctors would prescribe the medicine and explain how they are taken to the parents. However Lia would always get sick quickly afterward; since the parents had no way of understanding due to the language barrier and even if it was translated to them by the janitor or Lee’s relative, the parents had no way to write the directions down because they were both illiterate. Furthermore, Lia’s parents do not usually give the medicines prescribed to her by her doctors. They believe western medicine is bad and that it would make their daughter even more ill.

MCMC doctors and nurses do not usually like treating patients from the Hmong society due to the language barrier and cultural differences. They dislike Hmong patients to the point that the doctors sarcastically say the preferred method of treatment for the Hmong patients is high-velocity transcortical lead therapy, which means that the patient should be shot in the head. Hmong behavior and cultural beliefs stress the hospital staff. For instance, the nurses get stressed and anxious when a Hmong woman does not make a sound when she is in labor pain. Many Hmong medicine taboos have been troublesome, some of which are very important in helping with diagnosing a patient’s health problem; such as blood tests, spinal taps, surgeries, anesthesia, and autopsies. This causes frustration for the medical staff since these are the only methods they learned and needed in order to help the patients recover. Hence, when Hmong patients reject whatever treatment their doctors give, the doctors become irritated as they have no other way to help the Hmong people aside from what they have learned in medical school. One incident was when resident Dr. Benny Douglas had a patient who was an elderly Hmong woman with gastric cancer and he wasn’t able to persuade her sons to consent to her surgery, this led resident Dr. Benny Douglas to develop severe insomnia from the frustrations.

Western medicine is unfavorable in the Hmong culture and society, because to the Hmong the American doctors perform things so differently to what they have seen done by their shaman the “txiv neeb”. For example, the txiv neeb is considered polite, doesn’t ask personal questions, and knows how to treat the patient’s body as well as soul. As for American doctors, they are considered to be rude for asking intimate questions of the patient’s life and when a doctor treats a body, they do not mention treating a soul. Surgery is taboo in the Hmong culture because if the body is cut or disfigured, or loses any of its parts, it will remain in a condition of a perpetual imbalance and the damaged person not only will become frequently ill and physically incomplete during the next incarnation. As for autopsies, if people lose their vital organs after death, their souls cannot be reborn into new bodies and may take revenge on living relatives. Miscommunication between the American doctors and their inability to successfully treat their Hmong patients has negatively affected the Hmong people, some who even started committing suicide. One incident was when a Hmong father hanged himself in a prison cell due to being unfairly arrested for child abuse. One Hmong way of treatment is rubbing a coin on the skin, this treatment would leave a mark, therefore when a doctor sees a Hmong child patient with these marks on their skin they would assume that they were being abused and the doctor would file a report against the parents for abusing their child.

Works Cited

1. Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Farrar, Straus and Giroux, April 24, 2012.