The Spirit Catches You and You Fall Down
by Anne Fadiman
Farrar, Straus, & Giroux
September 1997
Hardcover: ISBN: 0-374-26781-2
Paperback: ISBN: 0-374-52564-1

A study of cross-cultural communication and medicine, set in modern day California.

It should come as no surprise to anyone that when the inhabitants of a Fourth World country encounter those of the modern "First World," there is bound to be some misunderstanding. But when that encounter takes place in a county hospital in California, a state with a modern economy, it comes as somewhat of a shock to realize that the divide between cultures can be so great that even a modern health care system can tragically fail a patient.

In 1982, a three-month old baby was carried into the emergency room at the Merced County Hospital in California. The parents spoke no English. And the doctors spoke no Hmong. To the doctors, it was clear that baby Lia Lee was suffering from severe epilepsy. To the parents, it was clear that Lia's soul was leaving her body, in the Hmong language, qaug dab peg, "the spirit catches you and you fall down." What follows, then, is a tragic story of miscommunication. Lia's doctors do everything they can to help Lia, and express frustration over the family's apparent inability or unwillingness to follow the prescribed medical regimen. The parents, on the other hand, do everything they know they must do, concocting home remedies made from herbs grown in their courtyard and having their shaman sacrifice animals.

The book is thoroughly researched (it took Fadiman eight years to write) and illuminating, depicting the intractability of both an immigrant culture doing its best to survive in a community it does not understand and a medical community which is unable to see outside its own paradigm of treating illness. It is a testament to Fadiman's skill as a writer that she empathizes with both the parents and the doctors. And by focusing on one story, she is able to deftly weave in explanations of Hmong spirituality and medicine, their role in the Vietnam war, and their emigration from Laos to America. Explanations of epilepsy and modern medical and social welfare procedure in America also are detailed-- not as dry, technical explanations, but as essential components of Lia's story.

But you may not be interested in epilepsy. Or medicine. Or culture clash. Or the Hmong. Or California's public health system. Read the book anyway. Fadiman did not write the book as an educational tome (although the book is now required reading in a number of medical schools, anthropology, and journalism classes). Instead, she eloquently lays out Lia's story as if it were a novel: introducing us to the people involved, laying out the timeline of the progression of her disease as if it were a mystery, and following the action back and forth between two cultures. What could have been a four page magazine article becomes instead a powerful and haunting tragedy.

The book won numerous awards from the National Book Critics Circle, the Los Angeles Times, Salon, and the Boston Book Review. It got raves from the New York Times, and made the best book of the year list for People, Newsday, and the Detroit Free Press.

More info:
The Spirit Catches You and You Fall Down Web site, <>

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