cultural differences often impedes progress. “The Spirit Catches You and You Fall Down” by Anne Fadiman takes a dramatic look at what occurs when cultures class in the area of healing and healthcare. The book is set in both Merced, California and the country of Laos in Southeast Asia. The primary characters are the Lee family which is composed of the daughter Lia, the mother Foua Yang and the father Nao Kao. The Lee family belongs to the Hmong ethnic group which are descendants of the Chinese Miao and reside in Laos, Thailand, and Vietnam.

Overall Fadman wants readers to see and perhaps acknowledge the fact that there are very real cultural differences that exist in the world. The American way of giving care to patients is not necessarily the best way and in some cases it can be detrimental because it tends to be one-dimensional as opposed to the Hmong approach which multidimensional. The author seems to want readers to understand that cultural differences should be understood and examined instead of ignored or ridiculed. Had the American doctors implemented some eastern medicine into the regime perhaps Lia’s condition would have improved. The author focuses on the concept of cultural inclusion.

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The Lees are faced with a medical crisis because their daughter Lia has epilepsy and suffers from Grand Mal seizures as a result. The entire story revolves around how best to treat Lia’s disease. The daughter is having severe Grand Mal seizures which are decreasing her quality of life. The Lees need and want to get help for their child.

Differences between healthcare in America and Laos

On the one hand American or western culture tends to approach healthcare from the point-of-view of the latest scientific research and medicines available. On the other hand, in Hmong or Eastern culture there is a more holistic approach to caring for the ill. This approach takes onto consideration not only the body or the physical ailments that someone has but also to the healing of the mind and soul. In eastern culture all of these elements work together to keep people healthy. When one element is not taken into consideration will caring for the ill the belief is that the person will not get any better. For the better part of the book a significant amount of tension exist between the American doctors and the strategies they use to assist Lia and the Lees trying to get the American doctors to understand the importance of treating the ehole patient and not just the body. The Hmong people also have certain beliefs about collecting various bodily fluids especially blood. The book explains that “most Hmong believe that the body contains a finite amount of blood, that it is unable to replenish, so repeated blood sampling, especially from small children can be fatal (Fadiman 1998, 33).” As such Lia’s parents had a difficult time accepting some of the care given to their daughter because American doctors tend to take a great deal of blood in attempts to find out what may be causing an illness. This difference in the manner in which American doctors operate is a major source of tension.

In addition there are differences between the cultures as it pertains to how patients and doctors interact. American doctors lacked the personable approach that is expected of doctors in Hmong culture. In addition, the Hmong approach to medicine seems to be less intrusive and governed more by spiritual beliefs than scientific beliefs.

Hmong Culture

The actions and behaviors of the Lee’s seem consistent with the history of the Hmong people. In many ways the parents were stubborn and reluctant to change their ways and follow the instructions of the doctors. This obstinacy may have been caused by the need that the Hmong people have long had to preserve their culture and their way of life. The mother in particular seemed to be resistant to following the doctor’s orders. The actions of both parents seem to be reluctant to conform to the American way of thinking and caring for those who are ill.

Reluctance to Administer Medicine

The reluctance of the Lee’s to give their daughter the medicine as prescribed is understandable given the cultural differences and the fact that they were illiterate in both English and Hmong language. They just did not understand how to administer the medicine and how it would work to heal their daughter’s body. The American doctors should have also made sure that the parents understood how and when to administer the medications. The doctors gave the parents medicine and assumed that they were administering it correctly. The American doctors also failed in this regard because they did not attempt to understand more about Hmong culture, these are proud people . If they understood more about Hmong culture perhaps they could have explained the use of medicine in a more sensitive manner and in a way that the parents could have understood and digested. The doctor also questions his policy of not tailoring Lia’s medical care in a way that would make her parents more likely to adhere to the instructions given by the doctor. It seems that both sides were unwilling to compromise what they believed as it pertained to Lia’s medical care.

There is also a point in the book where the mother stops using the anticonvulsion medicine altogether because she believed that people should not stay on any medicine for too long. In addition the parent stop giving their daughter any of the medication for a three-month period. This resulted in Lia having a severe Grand Mal seizure which caused her to be intubated and caused developmental delays in Lia.

On the one hand, I understand that the parents cultural beliefs were deeply ingrained in them and they had difficulty breaking away from those beliefs. On the other hand, thae parents seemed not to understand cause and effect. They didn’t understand that the seizures were occurring as a result of them not administering the medication or not administering the amount needed to treat their daughters condition. The Hmong people tend to believe that someone’s physical condition is in the hands of the spirits and that they really don’t have control over what happens. With this understood, it did not matter if the medicine was administered or not. The American doctors saw her actions as a type of complacency. American medicine tends to emphasize the idea that there is some control and that people have to own this control to heal physical illness. The Lee’s were conflicted and it seems that they truly believed that what they were doing concerning the administering of medication was the right thing to do.

How the healthcare providers treated Lia and her parents

The healthcare providers saw Lia and her parents as a challenge. There is a great deal of frustration coming from the healthcare providers. These frustrations is the result of several issues. At one point in the book the staff is hoping that Lia will not be admitted to the hospital because of the difficulty associated with caring for her. Their feelings about Lia have to do with her obesity which made her more difficult administer medicines intravenously. In addition once she was feeling better she would get out of her restraints and wander around the hospital looking for attention while other patients needed care. Those caring for her were also frustrated because the parents would not follow the care that they prescribed. Medical professionals get extremely irritated when patients are not following the appropriate regimens because it makes their jobs more difficult. In addition it is harder on the patients because they then have to deal with medical problems that could have been averted if they had simply followed the orders of the doctor. Overall it seems that the healthcare providers wanted to assist Lia but their ability to do so was severely diminished by the actions of their parents. The family became a nuisance to the healthcare providers.


The story of Shee Yee, the healer and how he fought with nine evil dab brothersis reflective of Hmong culture in several ways. Obviously Shee Yee had courage and was willing to fight against things that threatened a certain way of life. In this respect he was stubborn. He was not willing to compromise his beliefs. This same kind of fighting presence was evident in the Lee’s. The father even threatened to physically harm one of the people who was trying to help them. Also the idea of traditions being passed on from generation to generation through folklore is consistent with Hmong culture.

What can the cultures lean form one another

The average American doctor could probably learn the art of patience and being more personable with patients from the Hmong Shaman. In addition the American doctor could learn to take a more spiritual approach in the way that patients are addressed and in the area of treatment. The Hmong Shaman could learn that people do have some control over their physical bodes and that science can be used to exert this control. Both healers could learn how to incorporate techniques that may be different from their respective cultures into how they treat medical conditions.

Ultimately Lia was put into foster care because the doctor believed that the parents were not caring for her properly. Lia’s foster parents were Dee and to Korda. They had children of their own and wanted to care for Lia. Lia needed a great deal of care and affection and her foster mother gave her this affection even to the point of . I was not surprised at the level of affection; I was somewhat surprised that the foster mother breast fed Lia right along with her biological child. The foster parents did not belittle the Lees. Te foster parents tried to understand the Lee’s perspective on medical care but they also understood the perspective of the American doctors and the fact that Lia needed to receive her medications. Although the Kordas were following the medical regiments prescribed by the doctors, her conditioned worsened. Ultimately the Kordas recommended that Lia be returned to her parents because they believed that being away from them was making her even sicker. This belief goes back to the belief that the Hmong have the spiritual condition of a person can have a profound impact on their physical condition. Ultimately it seemed that removing Lia from her parents did more harm than good and the Kordas recognized that a mistake had been made.

The social worker was able to garner the trust of the Lees because she was patient and took time to listen and understand their perspective. The social workers way of communicating with the Lees made them more comfortable and decreased their fears. This type of patience was not present with the other Americans instead they were frustrated and there was a great deal of tension. It should also be noted that the social worker was removed from having to deal with administering medical care so there was a different perspective that the social worker could take.

Even though Lia is extremely young and cannot speak for herself, I feel tha the author really captured Lia’s voice and spirit. Lia probably just wanted to be well; this is the sentiment that is derived from the book. A great deal of what happened to her was out of her control. She did not choose to be sick, she didn’t choose her medical treatment, and she didn’t choose to be taken away from her parents. All of these things had a profound effect on Lia’s ability to function as a normal child. Even though Lia could not speak for herself she is obviously a person with value. Afterall the whole book was about trying to increase her quality of life and how to save her life. Lias Parents, the Kordas and all of the medical perfessionals believed her life to be of value. Even though the medical professionals were frustrated with the way her treatment was going you still got the feeling that they wanted her to be well. The doctor who got child protective services involved also believed that it was the right thing to do and the only way that Lia’s life could be saved. A great deal of energy was expended to try and make Lia well because she was important and valuable.

Overall this book demonstrates the serious problems that arise when cultures clash and people of different cultures do not know how to compromise. The book echoes the idea that there was some truth to both cultures as it relates to the administering of healthcare. The Hmong’s cultures gentle way of dealing with patients and their relatives is something that American doctors can learn from. The Hmong culture emphasizes direct contact and gentle response to questions and reactions. Sometimes American culture is so fast paced and so driven by how quickly one can get results that it does not take into consideration the needs of the whole person. On the other hand, the Hmong culture could learn to be more aggressive in the way that bodily ailments are treated.


Fadiman a. (1998) the spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. Macmillan