The Spirit Catches You and You Fall Down: a Hmong Child, her American Doctors, and the Collision of Two Cultures

By Anne Fadiman

Place: Publisher & Year: New York: Farrar, Straus, and Giroux, 1997

Genres: nonfiction, social sciences, anthropology, cultural studies, medicine

ISBN: 9780374525644

Intended audience: Adult

Number of pages: 341 (including Notes, Bibliography, and Index).

Setting: Mostly set in Merced, CA, but also includes places where the Hmong have lived – including China, Laos, & Thailand, and other cities in the US.

Time period: Early to mid 1980’s (but the book also covers different times in the Hmong’s history – including America’s secret war in Laos)


Description: When Lia Lee, a Hmong child, was an infant, her older sister slammed the door on her way out.  Immediately afterwards Lia suffered her first epileptic seizure and Lia’s parents took her to the hospital.  Thus began a frustrating and strained relationship between Lia’s parents and hospital staff.  Language barriers and cultural expectations prevented Lia from getting the right care for her, leaving her in a tragic state of being.

Appeal factors:

Pacing: In spite of the heavy topic and volume of information, this book is an engrossing page turner.  Some parts read more quickly than others.  Fadiman alternates chapters  between Lia’s story and the story of how the Hmong came to the US.  The chapters dealing specifically with Lia moved quickly; the other chapters seemed more dense with  information and moved more slowly.

Characterization: Most of the book is written in third person, but Fadiman uses first person when relaying her personal experiences with the Lees.  Lia’s mother, Foua, and father, Nao Kao, are at the heart of the story.  Other important people in the story include Jeanine Hilt, Neil Ernst & Peggy Philip.

Frame: The title sets the frame for the story.  “The spirit catches you and you fall down” is the English translation of how the Hmong perceive epilepsy.  The phrase doesn’t make much sense in English and illustrates vast cultural differences in perceptions of disease between the Hmong and Americans.

Story line: Lia Lee was well loved by her family.  The doctors and nurses were giving Lia the best care that they could.  But the language and cultural differences between those involved in caring for Lia were so vast that tragedy ensued.

Subject headings:

From Pima County Public Library:

Transcultural medical care — California — Case studies.

Hmong American children — Medical care — California.

Hmong Americans — Medicine.

Intercultural communication.

Epilepsy in children.

Similar works:

The Scalpel and the Silver Bear by Lori Arviso Alvord and Elizabeth Cohen Van Pelt

Missing Michael: A Mother’s Story of Love, Epilepsy, and Perseverance by Mary Lou Connolly

I Begin My Life All Over: The Hmong and the American Immigrant Experience by Lillian Faderman

Crazy Like Us: The Globalization of the American Psyche by Ethan Watters

Personal notes: This was an amazing book.  Fadiman weaves together a few different complex stories with a seamless grace.  A couple people in my book group thought that parts were redundant and a bit too long (unspecified).  I didn’t feel this way about it.  I wanted more when it ended.  I wanted a miracle.  This is the first book which I chose for the book group.  I’m glad I chose it.  I first became aware of it when I worked at the UA Health Sciences Library.  This book was always on the reserve shelf because it was required reading for at least one class.  It should be required reading for all health professionals.

Other: Diversity – Hmong, doctors, nurses, shamans, child with epilepsy, refugees

Anne Fadiman’s webpage at Yale


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