The Spirit Catches You and You Fall Down

It has become a common complaint (sometimes valid, sometimes not, in my opinion) that immigrants 100 years ago wanted to become assimilated into the American culture as quickly as possible, whereas now they demand that the existing American culture adapt to them. But if you are unhappy with Mexicans or Pakistanis on those grounds, wait till you read about the Hmong! It is really not so much that they demand that Americans adapt to them, but that they cling to their own culture with a ferocity, a stubbornness, and a relentlessness, that is hard to believe. That culture includes animal sacrifices, a highly structured clan system, complex folk tales and hierarchies of spiritual beings, early marriage, and an eye-popping birth rate.

The primary focus of the book is how that culture clash made it nearly impossible for the epileptic child to be treated effectively either from the standpoint of Western medicine or in they eyes of the Hmong family who loved her. Fadiman goes into the history of the Hmongs in Asia and how their experiences have hardened them into the people they are now. It is very easy for the American layperson to lump them together with all other Asians, but that would be a huge mistake. Even to refer to them as "Laotians" - as I did before reading this book - would be a serious dismissal of their uniqueness. The Hmong have suffered hardships almost inconceivable in the eyes of modern Americans.

The book has no happy endings, and not an awful lot in the way of lessons. Fadiman provides some suggestions for what the American doctors and social workers should have done differently. (It's noteworthy that, like most multiculturalists, she says very little about what the HMONG should have done differently - even though Western medicine is demonstrably far more effective than the Hmong procedures of animal sacrifices and religious ceremonies.) Those suggestions, at the end of the day, would not have changed the outcome - at least not in my opinion. Those suggestions might have avoided some hurt feelings, and that in turn might have given the Hmong community a greater confidence in the doctors in Merced and Fresno. In that respect, things might have been better over the long term than they are now.

But the primary lesson I came away with was that there is an almost impenetrable barrier between the two cultures, and that it certainly would have been far better if the Hmong had never been forced to come here. And underlying THAT lesson is the realization of the incredible cruelty that is visited upon otherwise peaceful people when the "Great Powers" make pawns of them in a global conflict. The only reason the Hmong are in Merced is that Southeast Asia was a battleground between the United States and the communist countries, and that each side was willing to use any means to win - even at the cost of the complete destruction of people the like Hmong.

I have no hesitation in stating that I think communism was evil, and that we were right to fight it. But did anyone ask the Hmong, and other people like them, whether THEY were willing to pay the price for the victory of democracy? And did we have the right to decide for them? This book will have you thinking about those questions and more, long after you close the last page. And you are unlikely to find easy answers.


Eye-opening and sobering   July 30, 2000
John Rummel (Madison, WI)
18 out of 20 found this review helpful

As a professional educator who works with Hmong students and their families, I relished the opportunity to read this book, hoping to gain some understanding into the culture and values of the Hmong community. What I got was a fist-in- the-gut experience that left me practically breathless. I finished the book in less than a day - a day in which I accomplished little else. Fadiman knows her topic well and writes with refreshing clarity and brutal honesty. The Hmong are resistant to adaptation of western values - a fact that had long frustrated me and left me somewhat skeptical of their willingness to adapt to life in this country. I now realize that the clash of cultures goes well beyond geographic and language issues. Deeply spiritual and devoted to their families and clans, every facet of Hmong life revolves around the spiritual.

Fadiman's book is a cross between a case study and ethnic history. The case is that of a young girl stricken with epilepsy, and her family's struggle against western medicine and medical doctors. The history is a broad ranging but concise history of the Hmong people.

I highly recommend this book for anyone interested in culture clashes, and especially for anyone who knows a Hmong, or works with them. It will open your eyes.


A divine liqueur distilled from a murky cultural clash   April 6, 1998
Daniel Murphy (Redmond, OR USA)
26 out of 28 found this review helpful

I was one of the physicians involved in the care of Lia Lee. I'm referred to in the book as the physician that first diagnosed Lia's spells as seizures. Neil Ernst and Peggy Philp, the principal pediatricians in the book, were and are good friends of mine. Having experienced Lia Lee's saga personally, and then having read the book, I can only refer to Anne Fadiman's talent as astounding. Anne walks an incredibly fine, and very well documented, line as she describes what happens when American medical technology meets up with a deep and ancient Eastern culture. My team (Western medicine) failed Lia. Never have I felt so fairly treated in defeat, and never have I felt so much respect for an author's skillful distillation of a tragically murky confrontation of cultures. Incidentally, the hospital administrator of the hospital I'm currently associated with rated the book "The best book I read in 1997". He reads prodigiously. Dan Murphy, MD


A rare honest voice.   December 1, 2000
Cynthia Raxter (BYNUM, NC USA)
8 out of 8 found this review helpful

A simple story at the beginning of this book illustrates how honestly it is written: A Hmong tradition is to make a special soup for a woman that has just given birth -- to restore strength after labor. Loving family members visited Hmong patients, delivering broth.... One OB intern described it as small steaming pots of soup, smelling heavenly. In another interview it is described as a vile brew, stinking up everything.

A rare honest voice, Anne Fadiman does not write in shades of black and white -- instead she presents a multicolor kaleidoscope for the reader to interpret. Judgement and ego belong to the reader.

If you remember the news stories from Laos 30 years ago and wondered what the real story was.... this is the hopefully true and fair account of the people displaced. It is not a "big bad Americans" story. It is a story of how many people, beside around and over the system, manage to persist, survive and succeed.

Yet the principles and values that made us succeed can also be our undoing. Without a willingness to adapt, good people doing their best can still fail. In this book good doctors, caring nurses, dedicated social workers and a loving family cross purposes taking care of a very sick little girl.

The misunderstandings are at times hilarious. Knowing the American doctors always wanted them to take their clothes off (unlike their shaman that burned herbs and prepared broths and teas) an old gentleman chose the best undergarment from the charity box for his annual physical -- heart imprinted panties and a Wonder Woman T-shirt. At other times you feel the medicos frustration -- not being able to convince a Hmong family an appendectomy is needed: pills cured their son last year when he was very sick with strep throat -- why not now? Besides, if he has surgery a spirit will catch his soul! They cannot fathom how much they need to change and the doctors cannot fathom why the superstitions persist. The author presents the history of the Hmong -- and we understand -- the "superstitions" had protected them through incredible persecution and life in remote mountains for over a thousand years.

And threaded throughout the story of the sick little girl and her ethical caring doctors -- the interwoven Hmong history and the incredible compassion shown by many -- is a beautiful story of a family's love for their daughter. The Hmong culture teaches a child is a gift from God and thus must be treated so. Perhaps that is the best pearl of all.

If you read Barbara Kingsolver's Poisonwood Bible, this would be a good non-fiction book to accompany it. It would make a thoughtful gift. I was intrigued by the title... I didn't put it down until I had read the last page.