The book “The Spirit Catches You and You Fall Down” by A. Fadiman is dedicated to the Hmong culture that is portrayed with the help of a detailed review of its history and the tragic demise of Lia Lee. The plot of the book is divided between these two stories. While a half of the chapters describe the life of Lia, the other half explores the Hmong culture. The first part of the plot shows how the unique cultural characteristics of the Hmong and inability of the doctors to use a cross-cultural approach in Lia’s treatment resulted in her death. Even though her epilepsy could have been successfully cured, a contradiction between the western medicine and the mythological world outlook of Lia’s parents became an insurmountable obstacle. The second part of the plot describes the Hmong history. It shows how the ethnic group decided to fight the Chinese, moved to Laos, Thailand, and Vietnam in an attempt to survive, engaged in the Vietnamese war against the communists, and immigrated to the United States. The two components of the plot harmonize with each other and lead readers to a conclusion that the cultural factor is critically important in medicine, and cross-cultural programs are mandatory in modern health care.
The first two chapters introduce the Hmong culture to readers. They briefly describe the history of this ethnic group up to the 1920s and illustrate the peculiar traditions of these people on the example of Lia’s birth and the so-called soul-calling party. The third chapter reveals the problems that Lia’s parents encountered while trying to treat their daughter. The fact that they did not know English made diagnosing more complicated. Simultaneously, their perception of epilepsy as a certain form of distinction discouraged them from seeking effective treatment. The fourth chapter explains that the Hmong rarely trust western doctors because their behavior and treatment techniques contradict the traditional Hmong beliefs. In particular, western specialists ask personal questions and demand patients to undress which is not acceptable in the culture of this ethnic group. The fifth chapter describes the communicational and cultural problems which resulted in a significant worsening of Lia’s health. The principle of syncretism explained in the sixth chapter helps to understand why Lia’s parents stopped giving her medicine that was prescribed. Even though Lia was taken into foster care, her health state continued to worsen. After returning home, the situation did not improve. In contrast, the mental capacity of Lees’ daughter has significantly declined. The set of traditional rituals implemented by Lia’s parents in order to heal her was of no effect. Furthermore, after hitting her head, Lia went into status epilepticus. Resistance to western medicine and the reasons behind it are explored in the 10th chapter within the framework of the Hmong culture and the value of incompliance.
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During the next big seizure, doctors were unable to save Lia, and she became brain-dead. Her parents’ reliance on the ambulance became erroneous as Lia had lost several minutes that turned out to be critical. The 12th chapter draws an analogy between the story of Lia and the Hmong’s reliance on the U.S. during the Vietnamese war. In both cases, people’s mistakes led to tragic consequences. A similar analogy is made in the next two chapters as the American health care system’s failure to treat Lia might resemble the country’s inability to ensure a proper settlement of Hmong refugees.
Despite the doctors’ forecasts, Lia did not die which, in her parents’ opinion, demonstrated the effectiveness of their traditional healing techniques. The situation with Lia convinced the Hmong not to trust the American healthcare system. The 17th chapter shows how Lia’s parents tried to avoid interacting with doctors even when they had an obvious need for medical treatment. However, the author assumes that Lia’s death was not only a result of the parents’ ignorance but also a consequence of the doctors’ incompetence. If the doctors had used the cross-cultural approach, they would have succeeded, and Lia would have been alive.
The necessity of the cross-sectional approach in medical treatment is the main idea expressed in the book. The author claims that doctors must understand the unique cultural features of different ethnic groups and adjust their techniques appropriately. Even though traditional healing practices rarely have a positive impact on health outcomes, the inclusion of these practices and rituals in medical treatment as well as cooperation with local “shamans” may be effective instruments for treating the Hmong patients. This approach can also be applied to patients from other ethnic groups with unique and unrepeatable cultural traditions.
