The Spirit Catches You and You Fall Down: A Youdontsay Book Review

in #writing6 years ago (edited)

        At once an exhaustively researched piece of journalism and a compelling character drama, Anne Fadiman’s The Spirit Catches You and You Fall Down is a masterfully told story. Alternating between chapters of historical background and chapters of novel-like narration, Fadiman chronicles the history of Lia Lee, a young girl with severe epilepsy born into a refugee family from Laos who have moved to the United States to start a new life. With the aid of first-hand testimonies from the people who knew Lia best, Fadiman follows the deterioration of Lia’s health to the ultimate tragedy of her brain-death, all the while drawing our focus to the vast cultural gap between the Hmong family and the American doctors who try to help them. Fadiman is sensitive and wise enough to avoid placing the blame on either party, but she uses every opportunity to expose failures in communication and to juxtapose the spiritual culture of the Lee family with the coldly logical system of American medicine. If her book can be said to have a singular thesis, it is undoubtedly that a cultural void between doctor and patient can lead to irreparable harm.

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        The title The Spirit Catches You and You Fall Down seems to convey this message. These are the words which Foua Lee uses to describe her daughter Lia’s condition. While an American doctor would describe the condition as epilepsy, a neurological disorder with a strictly physical origin, the Lees believe that the condition is spiritual in nature. This disparity is cultural ideology is already being instilled in the reader’s mind from the first pages of the book, where Fadiman describes the difference between a traditional Hmong birth and a birth in an American hospital. A Hmong birth is a spiritual affair, involving little practical medicine but a laundry list of religious rituals to protect the soul of mother and child. In the delivery the mother simply squats over the ground, and afterwards there is a crucial ritual involving the placenta, which must be carefully buried in a specific way to ensure the spiritual and physical health of the newborn. Lia’s American birth, in contrast, seems oddly horrifying and mechanical in spite of its logical efficiency. Fadiman writes, “Foua was lying on her back on a steel table, her body covered with sterile drapes, her genital area painted with a brown Betadine solution, with a high-wattage lamp trained on her perineum. There were no family members in the room” (Fadiman 6). Contrasts like these may not convince an American reader to condemn modern medicine or begin burying placentas, but they allow us to see things from the perspective of the Lee family and to understand how they might come to believe that American medicine might negatively affect Lia’s physical and spiritual health.
        Similar examples abound, driving home Fadiman’s point repeatedly. The Lees choose which medicines to give their daughter on the basis of color, which leads to Lia being taken away to a foster home, where her condition deteriorates. A failure in translation leads the Lees to believe that Lia’s primary doctor is abandoning her so he can take a vacation. They interpret a spinal tap—meant to diagnose Lia’s sepsis—as the direct reason for Lia’s brain death, and they interpret the brain death as her spirit being lost, simply absent. Even by the book’s end they have not been moved from this notion, and they perform a heartbreaking ritual in which they beg Lia’s soul to “come home.”

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        All of these moments are contained within the chronological narrative of the book, but Fadiman deliberately disrupts this narrative by inserting chapters of historical and cultural background between every chapter of Lia’s story. The first of these, “Fish Soup,” is used to justify the rest. It explains that in Hmong tradition, one must trace the causal chain as far back as possible in order to understand even a simple event like the preparation of fish soup. The chapters of historical background provide this causal chain, allowing us to further understand the cultural predispositions of the Lee family. In the chapter “Do Doctors Eat Brains?” we discover that many Hmong people legitimately believed Americans to be sinister, even vampiric people, and we can begin to understand the deep distrust the Lee family must have felt as they entered into the American medical system. Further chapters explore American intervention in Laos and Vietnam, the long history of violence between the Hmong and the Chinese, as well as a survey of other medical cases involving Hmong patients and American doctors.
        In her gracefully written preface, Fadiman tells us that she has “always felt that the action most worth watching is not at the center of things but where the edges meet… if you stand at the point of tangency you can see both sides better than if you were in the middle of either one.” She does exactly this in The Spirit Catches You, allowing us to better understand American medicine and Hmong culture by standing on the coast which divides them. Fadiman’s book does not provide all of the answers we might hope for, but it does not purport to. Fadiman is content to ask the right questions, exposing a serious issue in our medical system and teaching us to empathize with a culture we might otherwise have considered naïve. She accomplishes an impressive feat by crafting a book which is not only a historical document and a critique of our medical system, but also a beautifully written, emotionally gripping tragedy which will have a lasting effect on anyone who reads it.

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Excelente como siempre @youdontsay

The picture is so funny .lol

Wow fascinating review - what an interesting topic. Even Americans distrust and have deep misconceptions about American healthcare/doctors (okay some of it is legitimate and not misconception - American healthcare system kinda sucks, lets be honest), but trying to navigate the healthcare maze with totally different cultural referents has to be near impossible. Really enjoyed this post :) Much love - Carl

Thank you Carl! And I agree-- hospitals are a nightmare for anyone, and I can't imagine how much worse it must be when there's a huge language/culture barrier between the doctors and patients

Gracias...

Excellent article. I really liked it. Good luck to you and Love.

Отличная статья. Мне очень понравилось. Удачи Вам и Любви

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