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

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The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures Cover

ISBN13: 9780374533403
ISBN10: 0374533407
Condition: Standard
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Reading Group Guide

Questions and Topics for Discussion

The two cultures

1. Do you think the author was evenhanded in her presentation of Hmong culture and medical

culture?

2. The book contains many Hmong phrases and many medical phrases, both unfamiliar to most readers. Why do you think the author included them?

3. Over the centuries, the Hmong fought against many different peoples who claimed sovereignty over their lands. What role has this tumultuous history played in the formation of Hmong culture?

4. How does the Hmong folktale about how Shee Yee fought with nine evil dab brothers, told at the end of chapter 12, reflect Hmong culture?

5. What do traditional Hmong consider their most important duties and obligations? What do American doctors consider their most important duties and obligations?

6. In chapter 18, Fadiman writes, “As William Osler once said—or is said to have said—‘Ask not what disease the person has, but rather what person the disease has.” How might the events of this book have unfolded if Oslers dictum were universally followed in the medical profession? How would your relations with your own doctors change?

7. In matters of attitude, what might the average American doctor learn from a Hmong txiv neeb (shaman)? What might the txiv neeb learn from the doctor?

8. In her preface, the author says that while she was working on this book, she often asked herself two questions: “What is a good doctor?” and “What is a good parent?” How do you think she might have answered her own questions? How would you answer them?

9. At the end of chapter 18, Sukey Waller asks, “Which is more important, the life or the soul?” What do you think?

The characters

10. The Spirit Catches You and You Fall Down revolves around a small child who for much of the book is too young to speak for herself, and at the end is unable to. Do you nonetheless feel you know Lia Lee? Do you believe that even though she cannot walk or talk, she is a person of value? Why?

11. In chapter 8, after describing Fouas competence as a mother and farmer in Laos, Fadiman quotes her as saying, “I miss having something that really belongs to me.” What has Foua lost? Is there anything that still “really belongs” to her?

12. How do you feel about the Lees reluctance to give Lia her medicine as prescribed? Can you understand their motivation? Do you sympathize with it?

13. In chapter 7, Neil Ernst says, “I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids lives.” Why didnt this message get through to the Lees? If you were Neil, would you feel this way too?

14. In chapter 15, Foua, who has heard that one of the Ernst sons has leukemia, embraces Peggy. After all the conflict between them, why are they finally able to resolve their differences? Do you think this could have happened earlier?

15. Since the publication of the book, Anne Fadiman has said that if she lived in Merced, she would choose Neil and Peggy as her childrens pediatricians. Would you?

16. Fadiman describes May Ying Xiong as not just an interpreter but a cultural broker. Whats the difference? What were May Yings contributions to the book?

17. Were you surprised by the quality of care and affection given to Lia by her foster parents? How did Lias foster parents feel about Foua and Nao Kao? Was foster care ultimately to Lias benefit or detriment?

18. The only American who fully won the Lees trust was Jeanine Hilt, their social worker. Why did Jeanine succeed where so many others had failed?

19. The book contains brief but important sections on three Hmong leaders—Jonas Vangay, Blia Yao Moua, and Dang Moua—who are multilingual and gainfully employed. What did they teach Fadiman? Why did she include them?

The writing

20. How might this book have been different if it had been written by a Hmong? A doctor? An

anthropologist?

21. From a writers point of view, what are the advantages and disadvantages of being an outsider in the two cultures Fadiman explores?

22. “The spirit catches you and you fall down” is a literal translation of the Hmong phrase for epilepsy. Why do you think the author chose such a long and difficult title?

23. The book has an unusual structure: Lias story occupies the odd-numbered chapters, and background material occupies the even-numbered chapters. Why do you think Fadiman organized her narrative this way?

24. At the beginning of chapter 2, Fadiman tells the story of a Hmong student who gave an oral report on Fish Soup. What is the concept of “fish soup,” and how is it reflected in the book itself?

25. One of the ways by which Fadiman places the doctors and the Lee family on equal footing is her decision to refer to all of them by their first names (instead of saying, for instance, “Dr. Ernst”). What are some other ways?

26. Many readers have commented that The Spirit Catches You and You Fall Down is a book without villains. Do you think that from a literary point of view this is a flaw?

Other Books of Related Interest

Virginia Barnes Lee, Aman: Story of a Somali Girl; Michael Bérubé, Life as We Know It; Robert Olen Butler, The Deep Green Sea; Lan Cao, Monkey Bridge; Temple Grandin, Thinking in Pictures: And Other Reports from My Life with Autism; Jamaica Kincaid, My Brother; Maxine Hong Kingston, Woman Warrior; Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales; Esmeralda Santiago, When I Was Puerto Rican; Susan Sheehan, Is There No Place on Earth for Me?; Abraham Verghese, My Own Country: A Doctors Story.

What Our Readers Are Saying

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Average customer rating based on 3 comments:

melbutler02, October 24, 2013 (view all comments by melbutler02)
As a medical provider, I found Anne Fadiman's book extremely eye-opening and insightful. Part history of the Hmong culture (the ethnicity depicted in Clint Eastwood's 2008 film, Gran Torino) and part biography of an epileptic toddler and her family's struggles with the American healthcare system, Fadiman describes The Spirit Catches You and You Fall Down "not as the book about the Hmong but as a book about communication and miscommunication across cultures." I originally picked up this book to learn more about epilepsy but found myself realizing and redefining my own intolerance to other cultures.
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(1 of 1 readers found this comment helpful)
Elena Adamo, May 2, 2013 (view all comments by Elena Adamo)
A must read for physicians and their patients. A provocative and educational look at the interaction of western medical culture with that of the shamans and spiritual animism of the Hmong.
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islander12, May 2, 2012 (view all comments by islander12)
Our book club read this, and at our meeting, we couldn't stop talking about the issues: the Dr/family miscommunications, what could the Dr's have done differently, what if our town had gotten a 10% population influx of Hmong immigrants on welfare, how would we have dealt with it? What was happening now in these hospitals? Have the Hmong integrated into the local culture any more? The little girl from the story, Lia, is still alive more than 20 years later in a persistent vegetative state, what would that be like? How could the Child Protective Service intervention been prevented? We wanted to know more about the Hmong migration and how their culture in the US is doing now?
Anne Fadiman captured the personal and the cultural in this story, and it was dense with detail, history and emotion.
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Product Details

ISBN:
9780374533403
Author:
Fadiman, Anne
Publisher:
Farrar Straus Giroux
Subject:
Civilization
Subject:
Anthropology - Cultural
Subject:
General
Subject:
Health and Medicine-Professional Medical Reference
Subject:
Pediatrics
Subject:
Disease & Health Issues
Copyright:
Edition Description:
Trade paper
Publication Date:
20120431
Binding:
TRADE PAPER
Language:
English
Illustrations:
Notes on Sources/Bibliography/Index
Pages:
368
Dimensions:
8.28 x 5.6 x 0.975 in

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Related Subjects


Health and Self-Help » Child Care and Parenting » General
Health and Self-Help » Health and Medicine » Essays
Health and Self-Help » Health and Medicine » General
Health and Self-Help » Health and Medicine » General Medicine
Health and Self-Help » Health and Medicine » History of Medicine
Health and Self-Help » Health and Medicine » Professional Medical Reference
History and Social Science » Ethnic Studies » Asian American
History and Social Science » Ethnic Studies » Immigration
History and Social Science » Sociology » General
History and Social Science » Western Civilization » General
History and Social Science » World History » Western Civilization

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures Used Trade Paper
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Product details 368 pages Farrar, Straus and Giroux - English 9780374533403 Reviews:
"Review" by , "Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different."
"Review" by , "Superb, informal cultural anthropology — eye-opening, readable, utterly engaging."
"Review" by , "This is a book that should be deeply disturbing to anyone who has given so much as a moment's thought to the state of American medicine. But it is much more....People are presented as [Fadiman] saw them, in their humility and their frailty — and their nobility."
"Review" by , "The Spirit Catches You and You Fall Down changed how doctors see themselves and how they see their patients. Anne Fadiman celebrates the complexity and the individuality of the human interactions that make up the practice of medicine while simultaneously pointing out directions for change and breaking readers' hearts with the tragedies of cultural displacement, medical limitations, and futile good intentions."
"Review" by , "So good I want to somehow make it required reading...The Spirit Catches You and You Fall Down explores issues of culture, immigration, medicine, and the war in [Laos] with such skill that it's nearly impossible to put down."
"Review" by , "This is a captivating riveting book — a must-read not only for medical professionals, anthropologists, and journalists, but for anyone interested in how to negotiate cultural difference in a shrinking world. Fadiman's ability to empathize with the resolutely independent Hmong as well as with the remarkable doctors, caseworkers, and officials of Merced County makes her narrative both richly textured and deeply illuminating. Sometimes the stakes here are multicultural harmony and understanding; sometimes they're literally life and death — whether in wartime Laos or in American emergency rooms. But whatever the stakes and wherever the setting, Fadiman's reporting is meticulous, and prose is a delight. From start to finish, a truly impressive achievement."
"Synopsis" by , The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lias parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy. Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadiman's compassionate account of this cultural impasse is literary journalism at its finest.
"Synopsis" by ,
The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lias parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy. Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadimans compassionate account of this cultural impasse is literary journalism at its finest.
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