Book 27 in Cannonball Read 2
Medicine is a cultural practice. Although we like to think of science as neutral, the practice of science - especially medicine, which involves so much interaction with other people - is filtered through our culture and beliefs. Anne Fadiman’s fantastic book The Spirit Catches You and You Fall Down explores the clash of two different cultures within a medical establishment, combining an engaging story of a young Hmong girl with epilepsy with an instructive treatise on Hmong culture and medicine. I’ll admit that this book falls right into an area of personal interest (the intersection of culture and medicine), but it’s good enough to recommend to almost anyone.
Fadiman starts by telling the story of Lia Lee, a Hmong girl with severe epilepsy. The title of the book - the spirit catches you and you fall down - is the Hmong description of epilepsy. In Hmong culture, epilepsy is understood as both a disease, and a blessing of sorts - it is an indication that the sufferer is in touch with the spirit world, and could become a shaman. The doctors who treated Lia over the course of many years worked hard (and received no fee) to treat her, but never understood this basic fact.
The Western medical view of epilepsy versus the traditional Hmong understanding is only the tip of the iceberg. Lia was given a complicated regime of medication, but her parents could not read or tell time to know when to give her the medication, or even differentiate which one was which. They relied on traditional healing methods to help their daughter, which led to CPS taking her away for a period of time. Her parents were heartbroken without her, and the foster mother - who had been a foster parent to dozens of children - states that Lia was the only child in her care who would have been better off with her parents.
The picture Fadiman paints is not of evil or incompetent people, but of a system trying to help a family without understanding the ways in which their culture is so fundamentally different, and interpreting their lack of understanding as belligerence and non-compliance. Fadiman does not turn anyone into a villain, she just shows people from different backgrounds trying to do what they identify as their ‘best’. It is all the more heartbreaking to learn that so many people involved in Lia’s case were trying so hard and looking out for her.
Fadiman documents the history of Hmong immigrants in America, but she wisely saves this for the later part of the book, after the reader is hooked into Lia’s fascinating story. The history of Hmong immigration post-Vietnam War is surprisingly unknown in America, such that many people do not even know what ‘Hmong’ means. The term refers to a group of people that have lived a nomadic lifestyle in Asia for centuries, driven out of place after place. The short version of the story of Hmong immigration to the U.S. is that they helped American forces in Vietnam, were promised refuge, driven out of Vietnam, Laos, and Thailand, so many chose to come to the U.S., where they faced rampant racism in an alien culture.
The Spirit Catches You and You Fall Down brings this hidden part of our history to the forefront, but is first and foremost the story of Lia Lee and the people who cared for her. This story is better than most novels I have read in the past few years - more poignant, more sorrowful, but also more full of hope.