The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman.

In The Spirit Catches You and You Fall Down, Anthropologist Anne Fadiman studies a refugee family from Laos and their experience in California hospitals. Fadiman examines the cross-cultural conflicts and lack of cultural relativism in the medical field. She chose to focus her research on the Hmong population in Merced, California, particularly the Lee family. The Lee family had a daughter, Lia Lee who had severe epilepsy. Throughout the book, Fadiman utilized observation, interviews with doctors, and interviews with the Lee family to gain a holistic overview of the clash of cultures.

Lia’s parents and her doctors both wanted her epilepsy to improve, and they both desired the best for her. However, many cultural miscommunications created irreparable damage to Lia’s health condition. The first factor Fadiman studied was the history of Hmong refugees. Hmong refugees were notorious in the Merced area for not assimilating and holding tight to traditional rituals and medicinal beliefs. However, Fadiman also notes that they were extremely misunderstood and degraded. The Hmong connections and care towards their family and passion for their culture stood out, and Fadiman noted their immense resilience. Fadiman observed that there was often no cultural broker or translator at the hospital to aid the Lee family. Oftentimes, the Lee family had no idea what was going on with their daughter, and they just saw her getting worse. As a result, they often did not give Lia her medication and resorted to traditional remedies due to their belief that the western medication was making her worse. Furthermore, the Lee family viewed her illness as a spiritual matter and saw her seizures as a consequence of an evil spirit catching her soul. Due to lack of communication between the doctors and the Lees, Lia was eventually sent to a foster home leaving her parents even more apprehensive and angry towards the hospital system. As time progressed, the doctors became more upset with the Lee family thinking the Lees were negligent towards their daughter.

Throughout the text, Fadiman analyzes the Hmong attitude towards Western medicine and the doctor’s view towards the Hmong and suggests future methods for better cross cultural communication. She asserts the importance of medical anthropology in preventing future scenarios similar to that of the Lees. She advocates for a model of mediation instead of a model of coercion and stresses the importance of communication and compromise. She says, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” Some additional recommendations from her studies were to use interpreters who were both bilingual and bicultural, allow shamanic ceremonies in hospitals, and practice conjoint treatment. She found that incorporating Western medicine with traditional medicine promotes trust and improved mental health and relationships between the doctor and patient.

Luckily more and more medical programs are now teaching their students how to maintain cultural competency and communication with models involving whole doctor-whole patient. In other words, they are teaching doctors to view the patient not simply through a medical lens, but also through a cultural lens. This book opened my eyes to the importance of medical anthropology in solving current public health issues and the grave consequences of cultural miscommunication. It also showed the need for further research and study of cultural issues in the medical field.

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