Synopses & Reviews
Winner of the National Book Critics Circle Award for Nonfiction
When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.
Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg — the spirit catches you and you fall down — and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.
"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." Richard Berstein, The New York Times
"Superb, informal cultural anthropology — eye-opening, readable, utterly engaging." Carole Horn, The Washington Post Book World
"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." Sherwin B. Nuland, The New Republic
"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." Perri Klass, M.D., author of A Not Entirely Benign Procedure
"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." Linnea Lannon, The Detroit Free Press
"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." Michael Berube, author of Life As We Know It
“Superb, informal cultural anthropology—eye-opening, readable, utterly engaging.” —Carole Horn, The Washington Post Book World
“This is a book that should be deeply disturbing to anyone who has given so much as a moments 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.” —Sherwin B. Nuland, The New Republic
“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.” —Perri Klass, M.D., author of A Not Entirely Benign Procedure
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.
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.
About the Author
Anne Fadiman was born in New York City and was raised in Connecticut and Los Angeles. After graduating from Harvard, she worked as a wilderness instructor in Wyoming before returning to New York to write. She has been a staff writer at Life, editor-at-large of Civilization, and editor of The American Scholar. Fadiman is also the author of Ex Libris and At Large and At Small, and the editor of Rereadings. She now lives with her family in western Massachusetts and serves as the Francis Writerin-Residence at Yale.
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
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?
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?
20. How might this book have been different if it had been written by a Hmong? A doctor? An
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.