For my cultural anthropology class last semester, we were assigned the novel The Spirit Catches You and You Fall Down by Anne Fadiman to read, and it was truly illuminating.
In this narrative nonfiction work, Fadiman, an American reportist and essayist, examines the need for culturally competent care in medicine through the story of Lia Lee. Lia is a Hmong child that suffers from a severe form of epilepsy referred to as “qaug dab peg” in Hmong, which translates to “the spirit catches you and you fall down” in English. As per traditional Hmong belief, Lia’s condition was a result of the separation of Lia’s soul from her body, and Lia’ parents instituted the use of a shaman, herbal remedies, and other “alternative” practices to try and cure her of the illness. Their efforts and values soon clash with those of the American physicians and medical staff at Merced Community Medical Center, the hospital tasked with her care. Through interviews with the medical staff assigned to Lia’s care and discussions of the customs and history of Lia’s refugee parents, Fadiman explores the ethnocentric ideals embedded in the United States healthcare system and reveals how the dismissal of other cultures’ beliefs can reap devastating, multidimensional effects.
The novel’s alternate title, A Hmong Child, Her American Doctors, and the Collision of Two Cultures, properly summarizes the primary issue throughout the work. American medical practice establishes a stark distinction between a patient’s disease and his or her state of health. Consequently, American medicine treats patients mainly through pharmacological or surgical means. Eastern cultures and the Hmong in particular assume a different approach in which health and disease exist as one, and medical practice is rooted in the experiences of previous generations.
The physicians tasked with Lia’s care viewed the animistic folk healing and shamanism used by Lia’s parents to treat her seizures as primitive and wrong, creating feelings of animosity and dismissal amongst Lia’s family towards the American health care system as a whole. Lia’s seizures worsen due to a combination of things ranging from a noncompliance from Lia’s parents to provide her with her medication to miscommunications between the medical team and her family on Lia’s needs. The question then stands at the end of the novel if these complications could have been prevented if there had been a greater effort on both sides to understand one another’s point of view.
As a future practitioner, this novel stands in my mind as a cautionary tale of the harms of ethnocentric practice on not only a patient’s prognosis and state of health, but also on their families and broader communities. The diversity in the United States in particular is ever-increasing, and the average age of our population is increasing alongside an increase in age-associated diseases such as Alzheimer’s, cataracts, osteoporosis, diabetes, and so forth. It is critical now more than ever for both medical practitioners and other individuals alike to recognize other cultures and take others’ viewpoints into consideration to prevent future cases such as Lia’s. I’ll definitely be more cognizant of how I view others’ approaches that differ from mine in the future.