Analysis Of Ann Faidman's The Spirit Catches You And You Fall Down

Cultural implications were evaluated from the Hmong perspective, using the book “The Spirit Catches You and You Fall Down.” The assessment was based on the Hmong people and followed the Geiger and Davidhizar’s transcultural assessment model. Five areas were focused on in particular from their model: Environmental Control, Social Organization, Communication, Space, and Time Orientation. The result reaffirmed that there is a huge cultural divide that caused many errors in the care of young Lia Lee, including many miscommunications that could have been prevented. I briefly touch on the importance of cultural awareness in the health care industry and why it is important to be sensitive to the culture of others.

“Americans can take come pride in the fact that attaining what the medical profession calls “cultural competency” is a goal of most health care institutions. However, achieving this goal in today’s health care environment, filled with diverse patient and provider populations, is no easy task. American hospitals are increasingly being staffed by and serving diverse populations. This creates the ideal breeding ground for conflict and misunderstanding among the staff and inferior patient care” (Galanti, 2011). To gain a more thorough understanding of this concept, I will be giving four examples or viewpoints that are completely different, when looking at the Hispanic belief against the Native American point of view.

Anne Fadiman’s novel, The Spirit Catches You and You Fall Down, addresses key concerns regarding health and medicinal relationships with cultural beliefs. She challenges readers to consider what is known about western medicinal practices and beliefs, based on science, and recognize its effectiveness when paired with cultural understanding. This novel portrays some of the greatest medicinal and health challenges and cultural failures of western societies. There were several cultural competency themes integrated throughout the book, however, it surprised me at how distant western practices and the Hmong’s healing methods were at the beginning. It seemed as if it would be a stretch to form a connection between these two extremities,

Lia is born of a loving Hmong family, and just three months into her life, begins to reveal epileptic symptoms. According to the Hmong community, the condition is curable, and the presence of spirits in such a patient’s soul is considered a blessing. However, American doctors in a community medical center fail to understand and appreciate Lia’s parents’ approach to the child’s disease, and are only interested in saving this child’s life. As the conflict develops, it becomes apparent that the child will not be healed; but this is not without the doctors realizing the importance of compromise. In this book, Anne Fadiman claims, “I have come to believe that her [Lia’s] life

This kind of cultural conflict led to Lia’s tragedy. Foua felt that it was important that there was a combination of western medicine and neeb. Knowing the history behind the Hmong could help a nurse better their care, by including their beliefs within their plan. The Hmong already felt that the United States had betrayed them by only choosing a select people, followed by not automatically taking those from the Thai camps, finding out they had no veteran benefits, Americans condemning them for taking all the welfare, and then taking it away from them. At this point they had little trust for people inside of the United States, so if the bedside nurses include their beliefs in some way, they could build a greater trust with them (Fadiman,

This prejudice is another strong concept, as the American doctors continued to underestimate, disrespect, and undermine Foua Yang (mother) and Nao Kao Lee (father) and their Hmong way of life. Vice versa, the Lees would refuse doctors’ orders in administering medicines. Ruane and Cerulo hit it right on the nail when describing prejudice,(20) which is a prejudgment directed towards members of certain social groups, as a feeling associated with immigrant groups, those that contain individuals who have left their homelands in pursuit of a new life in a new country. There is a clear indication of an in-group vs. an out-group, as it is noted from Second Thoughts, “an in-group carry unrealistically positive views of their group. At the same time…share unrealistically negative views of the out-group.” The cultural barriers are built due to “the one-sided relationship,” of knowledge only found in the unyielding West, with the prominent racial discrimination found among the white, English-speaking doctors and their intimidate dismissal of the existence of any Hmong medical practices/knowledge. The application of assimilation (20) is important to the in-group, as they simply believe that the immigrants will come to embrace the same values and customs of their new ‘homeland.’

“Medicine was religion. Religion was society. Society was medicine” (Fadiman, 1997). To the Hmong’s, this is a way of life. Everything in their culture is interrelated and represents a holistic view. As Americans, we try to incorporate the holistic approach into our health care system, but heavily rely on medications and science to treat illness.

“Between the ages of eight months and four and a half years, Lia Lee was admitted to MCMC seventeen times and made more than a hundred outpatient visits to the emergency room and to the pediatric clinic at the Family Practice Center.” The Lee family was a regular visitor at the hospital but it did not make thing between the Lee family and the hospital any easier. There was many issues between Lia’s family and the Merced hospital staff. Many of these issues steamed from many different areas of things. Between the Lee’s a Hmong family and the American doctors at Merced Hospital there were several cultural differences on what both parties wanted. Cultural difference was not the only thing they did not see eye to eye on there was also a huge language barrier between the Lee family and the workers at Merced hospital.

Many years ago, an epileptic Hmong girl named Lia Lee entered a permanent vegetative state due to cross-cultural misunderstanding between her parents and her doctors. An author named Anne Fadiman documented this case and tried to untangle what exactly went wrong with the situation. Two key players in her narrative were Neil Ernst and Peggy Philp, the main doctors on Lia’s case. As Fadiman describes, “Neil and Peggy liked the Hmong, too, but they did not love them… [W]henever a patient crossed the compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle.” (Fadiman 265) At first glance, this statement seems to implicate Neil and Peggy as morally blameworthy for a failure to be culturally sensitive enough. However, upon further inspection of the rest of the book, it becomes clear that Neil and Peggy’s failure to be more culturally sensitive to their Hmong patients was caused by structural issues in the American biomedical system. To prove this point, this paper will first present a background to Lia’s case, then discuss possibilities for assigning blame to Neil and Peggy, then show evidence for the structural issues in American biomedicine, before finally concluding.

The Spirit Catches You and You Fall Down, by Anne Fadiman, is the story of two very different cultures lacking understanding for one another leading to a tragedy due to cultural incompetence. Today in America there are very many different cultures. Health care providers need to be aware of cultural diversity and sensitivity when caring for patients. If a health care provider is not sensitive towards a patient’s culture it can cause a relationship of mistrust to form, lead to barriers in the plan of care, and increase health care cost. The current guidelines to promote cultural competence in the clinical setting include completing a cultural diversity self-assessment, identify the need of the population served, evaluate barriers in the community and practice, educate staff to cultural diversities, schedule longer appointments, clarify limitations, and identify alternatives offered (Cash & Glass, 2014).

When parents apply religious or cultural beliefs concerning spiritual healing, faith healing, or preference for prayer over traditional health care for children, concerns develop. This dilemma is unraveled in Anne Fadiman 's true story, The Spirit Catches You and You Fall Down, where the study of cross cultural medicine holds a significant value in all profession. The book chronicles the vast cultural differences between mainstream Americans and the Hmong, and how language and cultural barriers affected Lia 's treatment. To understand the Lees we really need to understand the Hmong culture.

The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive, yet problems do arise and it affects the quality of care the patient receives. Language barrier, poor socioeconomic status, and poor health literacy also contribute to health care disparity. For Lia, it was more than her skin color, it was all of the above, her parents did not speak English and they were illiterate. They had trouble understanding the American healthcare system, had trouble or little interest in adjusting to or understanding the American culture. They didn’t work, which in addition to cross cultural misunderstanding, helped contribute to animosity between the Hmong and the host community, because some in the Merced area did not like or appreciate the fact that some Hmong did not work and relied on welfare to make ends meet. All these factors, contributed to the poor quality of

In ‘The Spirit Catches You And You Fall Down’, Lia, a Hmong baby girl, is born to a Hmong family living in California as refugees away from their war torn land in Laos. In Laos the Lee’s where farmers and lived in the country according to their Hmong traditions and beliefs. In California they barely understood the language, much less Western culture or medicinal practices. In Hmong tradition, illness was seen as a spiritual problem rather than a physical problem and a Shaman that practiced spiritual ceremonies and used natural remedies was sought to prevent or cure certain illnesses and/or diseases; so when Lia suffered her first seizure at the age of 3 months and was taken to Mercer

“In the Spirit Catches You and You Fall Down”, Anne Fadiman explores the subject of cross cultural misunderstanding. This she effectively portrays using Lia, a Hmong, her medical history, the misunderstandings created by obstacles of communication, the religious background, the battle with modernized medical science and cultural anachronisms. Handling an epileptic child, in a strange land in a manner very unlike the shamanistic animism they were accustomed to, generated many problems for her parents. The author dwells on the radically different cultures to highlight the necessity for medical communities to have an understanding of the immigrants when treating them.