18 Dec 2022


The Spirit Catches You and You Fall Down

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Academic level: College

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The ‘Spirit Catches You and You Fall Down’ is a tale of Lea Lee, a Hmong child with an epileptic medical condition. The tragic demise of this patient demonstrates the tragic consequences of barriers in cross-cultural communication in the medical profession. According to the Hmong beliefs, people, particularly children experienced lost souls when they received insufficient love from the parent, loneliness or frightened by sudden loud noises. 

At three months old, Lia’s old sister banged the door of their bedroom and it is believed that the process led to her first seizure. Her parents strongly held that the sudden noise of the door caused her soul to escape. The family and friends then diagnosed her with an illness by the name of quag dab peg , or in other terms, “the spirit catches you, and you fall down.” Although the parents were concerned about the child’s safety, they treated her in a special way, seeing her seizure as special and as her epileptic condition chosen to be ‘tvix neebs,’ or ‘shamans.’ Even so, they brought her for treatments at the Merced Community Medical Center (MCMC), but they also observed traditional healing methods to try to bring back her soul. The family believed in little medicine and little neeb. However, they were concerned that too much medicine could cause problems and complication for their child. Similarly, the drug was seen as potential threat to the effectiveness of the spiritual healing. 

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On the contrary, Lis’s rationalist doctor treated her epilepsy as purely a neurological disorder. The physician provided the highest medical care with the appropriate medication. Due to lack of interpreters, the diagnosis was often misunderstood and correctly done. Medical administration became complicated with the parents reported to be either unable to follow the doctor's instructions or completely unwilling to do so or both. The parents gave adult dosage other than the prescribed child medication prescription. As a result, the parents became unhappy with the side effects of drugs, which led to complete failure to administer these drugs or partial administration of some drugs. Due to the lack of knowledge of seizure and the brain, Lia’s condition deteriorated even more. 

After suffering more seizures, Lia’s physician notified the Child Protective Service (CPS), which led to consequent child replacement into foster care. The separation of the child with the parent becomes worse for both Lia’s parents and her, leading to more devastating effects. When Lia was reunited with her family, the problem did not stop but escalated to an extent the condition left her brain dead. Consequently, the hospital instructed the girl be taken home hoping that she would die, but she continued to live up to 26 years. 

Critical Observations 

Throughout the entire book, the aspects of the Hmong history including culture, language, food, family and cultural rituals appear to be the main theme of the writer. As described in various chapters, the Hmong people lived in Highlands where they practiced various forms of agriculture and substance farming of rice, vegetables, pork, and chicken as well as traditional herbs. The group believed that there is a spiritual connection to every disease and that one can alleviate a decision though traditional and spiritual interventions such as birthing rituals, family rituals, and rubbing of skin with coins. Of most significance, however, is the sixth neeb, which is believed to have power, healing effects and even getting rid of evil spirits and restoring the lost soul. 

The book also explicitly describes how the Hmong loathes medication procedures and believes that the powerful family or cultural healing and the origin of diseases were in constant conflict with western medicine. This belief led to repeated misunderstanding between doctors and patients. Apart from western medicine, the animal sacrifice, and hospitalization issues, Hmong often corroded with their American neighbors to the belief they killed and sacrificed their dogs and other animals. The tragedy that follows Lia, in this case, is seen as results of a cultural collision between an old and outdated culture practice with the understanding and cooperation of a new model of understanding. 

Lessons of the story 


One key theme in this book is the concept of knowledge. While the knowledge of spiritual beliefs by the Hmong is recognized, the western doctors’ understanding and knowledge are considered superior and strong to that of Hmong beliefs. Although it is clear that the knowledge of the West is one-sided, focusing on the patient condition without the attempt or concern on the spiritual well-being, even Fadiman, who sympathizes with Lia’s condition focuses on the western method of treatment. In fact, Lia’s physician admits that it might be a medical error that caused Lia to lose a considerable part and function of her brain. The large dosage of medication could have been caused resulted in brain damage. The most interesting part is that even when the doctors declare that Lia’s brain is dead, the girl lives for the next 26 years. This longevity indicates that the love shown by the parent and the relatives played a more power role than that of the doctors. The question poses the interesting question of whether it's worth to seek for western knowledge and treatment or not. 


The theme of family, predominantly the strength Lia’s family possess, is depicted in this book. Unlike most Americans who had readily dis-passed the daughter to an institution for medication and care management, the Hmong group stuck with their daughter for 26 years, washing, cleaning and feeding her. This holistic care is expected to keep her alive for a considerably long period than predicted by her western doctors. Apart from the strength of Hmong families, Hmong present the highest number of family members of up to 9 children, each named after their ancestors. This hugeness and love continue to the point of revealing the oldest ancestors and their names given to the children. Hmong also accept the importance of the clan as seen in the acceptance of Lia’s parent to adopt one of the clan members as the interpreter. The group also lives interdependently and in unity, unlike the setting in the United Sates where everyone lives and fends for themselves. 


The love expressed by the parents, Foua and Nao Kao, inarguably seems to be the reason for the prolonged life seen in Lia. Other than Lia, the family and the community extended love to the social worker who was the custodian of the girl in the foster care. After extending love to her, she also responded by loving both Lia and her parents, and the clan. As a consequence, she alone seems to care and inquired about the parent's beliefs and attitudes towards Lia’s epileptic condition. Other social workers depicted in this book also inquired much on the clan or the family plan and ideas towards conditions like tuberculosis and other chronic ailments. Although Lia’s primary physicians liked patients from the Hong clan, there is no evidence that they expressed some form of love. In return, this could be seen as the reason for poor delivery of services. Such a method is viewed and recommended for adjustment to include holistic patient care goal. 

Hope amidst Loss 

Another key theme and an important lesson learned in this book is that there can be hope amidst losses. The majority of the Hmong population live in shattered dreams after the Vietnam war. Most of these family members and the clan live at the mercy of their friends. Although they give up all of their lands and freedom, the group agrees together with hope and a renewed faith. Even after migrating to a country where they are discriminated, harassed and miss treated, the group still clinched to hope and continued to thrive without complaints. When faced with a problem or a threat, the team remains stronger, united and undoubtedly stable. A good example is illustrated and shown on the continued hope that their daughter’s soul would return. 

Reflection, attitude, and emotion 

As seen in Freedman’s suggestion, the client or the patient should not experience coercion during the process of healing. The model of medicine appears to not only focus on the physical pain but also the emotional and psychological aspect. While the author presents the case that Lia’s physician appears to force and coerce her into accepting Western medication, information about equally mysterious treatment method is not provided. Similarly, the author presents what could be a possible unpalatable lack of proper medication and medical records during diagnosis and medical administration. However, the author appears to suggest or even allude that western education could be more accurate and exact in keeping medical records and following the documentation procedure. 

The feeling one experiences after reading this book is both of remorse and regret. The glaring challenge of a communication and cultural problem appear because of the demise of Lia. Lack of proper integration of culture leads to the thoughts of possible death. Consequently, the story evokes the attributes of care, love, sympathy and benevolence. Critical care and expressing of love become imperative when dealing with a patient. More importantly, the story evokes important reflection about the essence of presenting holistic care when dealing with the patient. Apart from just offering painkillers and other medication that the patient may require, the story evokes the feeling of being compassionate and interest focused on the patient’s emotional life and treatment. 


Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures . Farrar, Straus and Giroux 

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