Hardships of Medical System in 'The Spirit Catches You and You Fall Down'

Anne Faidman’s “The Spirit Catches You and You Fall Down” essay is a nonfiction book. In it readers can see how the book recounts the life and medical hardships of a Hmong youth named Lia Lee. Lia is an adolescent member of California’s Hmong population, Merced, which is a congregation of immigrants and refugees that had formerly resided in the hilltops of Laos. Lia is an epileptic who faces hardship in the American medical system, which in turn influences Fadiman to contemplate the attributes of American medicine while at the same time presenting an exhaustive study of the Hmong culture.

Contrary to Foua Lee’s thirteen other offspring, she gives birth to Lia in a hospital. Despite the fact that Lia is born without any medical issues, after her older sister Yer noisily slams a door she suffers from a seizure at three months old. Lia’s parents presume that this noise startled her, which resulted in her soul withdrawing from her body. Faidman discloses how this is a common conclusion amongst Hmong culture, which is an anomaly referred to as quag dab peg, “the spirit catches you and you fall down.” They believe that a dab is an evil spiritual being that prowls and stands by to oppress innocent humans by capturing their souls. This phenomenon typically characterizes someone as being physically adept to develop into a shamanistic physician, or txiv neebs, which is someone who has seizures so that they can confer with the evil beings, dealing and battling to recover the sufferer’s robbed soul. Txiv neebs are highly regarded individuals amongst the Hmong people, so even though the Lees are vigilant and nurturing parents who lament the casualty of Lia’s soul, they are simultaneously content with the thought of Lia possessing the potential to one day be a healer. They brought Lia for treatment at the Merced Community Medical Center, yet they also made use of time-honored healing techniques and recruited a txiv neeb to summon back her soul. Her family trusted in “a little medicine and a little neeb,” yet were concerned that excessive western medicine could hinder the efficiency of the spiritual mending.

Contrary to Lia’s parents, her realist doctors regarded her epilepsy exclusively as a neurological disorder. The Lees encounter Neil Ernst and Peggy Philp, who attempted to administer the best possible medical care. Yet, due to a lack of interpreters, Lia’s problem wasn’t accurately diagnosed until a few months following her first visit. Lia’s medical process was highly complex, and her parents either were incapable of following the doctor’s directions or were resistant to do so, or both. They were displeased with the side effects of her medication and might not have comprehended the correlation between a seizure and its impact on the brain, and not the urgency of administering anticonvulsant medication. Her parents' refusal had disastrous consequences, such as increasing the amount and severity of Lia’s seizures which began to indicate signs of medical retardation. Worried about Lia’s wellbeing, Neil informed Child Protective Services and had her taken into foster care. Even though her foster parents were amicable, the estrangement was excruciating for both Lia and her family. Jeanine Hilt, Lia’s social worker, instructed Foua on how to provide Lia’s medication so that their family could be reconciled. However, after four months of being home Lia needed to stay at the hospital for fourteen nights after going into status epilepticus. Two months thereafter Lia had suffered from an additional grand mal seizure, which would not end. It was discovered that she had septic shock which is a condition that had left her braindead. The doctors expected Lia to die, and authorized her family to take her back home. Lia didn’t die for another twenty-six years, and her family was able to continue to love and take care of her while allowing a txiv neeb to perform a ritual in order to alleviate her misery.

Infused with Lia’s story are sections dedicated to the record and culture of the Hmong, which provides the reader with a new perspective on the Lee’s viewpoint. The Hmong began in China where they fought the Chinese to preserve their culture. Instead of acculturating, most emigrated to Vietnam, Thailand, and Laos. At the time of the Vietnam War, the Hmong in Laos were enlisted by the CIA to combat the communist army. After the US pulled back their aid roughly 150,000 Hmong, which included the Lees, were involuntarily mandated to evacuate their homes to evade oppression. Most ultimately moved to the US where they encountered defamation, brutality, and an excessive amount of unemployment. Majority of Americans were begrudged over their neighbors dependence on welfare, uninformed of their engagement in the Vietnam War. The Hmong believed that they earned this assistance because of what they had given up to assist the US.

To end up, the persistence of the Hmong and their refusal to give up aided their survival for years to come. At the same time, it also made them distrustful of complying to doctor’s instructions. A factor that supported Hmong nonconformity was their superstitious beliefs opposing western medicine. They held the belief that operating on someone had the potential to lead to deformities not just in this life but in lives following, and that autopsy procedures could hinder a soul from being revitalized. Due to these taboos, western physicians continuously bumped heads with their patients of the Hmong culture. Faidman proposes that recognizing belief systems other than your own could make a large impact in bettering the end result for patients of various cultures. She provides instances of flourishing cross-cultural curriculums such as one where religious specialists or healers are bolstered in working side by side with western doctors. Faidman has had a large impact as her work has allowed the term cultural competence to be accepted as a vital attribute.