Culture and tradition as Theme in The Spirit Catches You and You Fall Down

This is another installment in my series of my MFA critical work. However, this book is essential reading and I will add it to the Official Book List in the future. It is a fascinating study of the culture of the Hmong people and their experiences in California. Fun Fact: the Hmong people, in the 5 decades since they arrived are actually incredibly wealthy now. They have done very well. In this piece, we’re going to talk about the interaction of culture and tradition in this wonderful work.

In The Spirit Catches You and You Fall Down, Anne Fadiman catalogs the story of Lia Lee, a child of Hmong parents from southeast Asia who move to California and how their traditional culture interacts with the American medical system. Ultimately, this is a clash between two traditions: one that has lasted since antiquity in the mountains of China, Thailand, Laos, and Cambodia, and the other being the modern traditions of American medicine. In the early 1980s, most people in Merced were not familiar enough with Hmong culture to help Lia Lee the right way. 

As a theme, the book constantly compares the usual American medical practice with the traditional ideas of the Hmong who simply had not been exposed to western, scientific thinking. The author does an excellent job of explaining Hmong culture and medical practices to draw a stark contrast between Western practices and the traditional Hmong practices. The author goes to great lengths to explain how the Hmong think and approach the world and uses this knowledge to explain how Lia Lee was unable to be adequately treated by American medicine and ended up in a vegetative state, cared for by family. 

The book catalogs the story of Lia Lee, a young Hmong girl who immigrates to the United States with her parents to Merced, California. The Hmong attitude towards American medicine was suspicious because their view of illness differed significantly from the American attitude. Their practices are typical of many traditional cultures where they rely on shamans and animal sacrifices to cure disease. In the case of Lia Lee, she had epilepsy which caused seizures. In the Hmong culture, this is considered a blessed illness indicative of an exceptional child who might grow up to be a shaman. The illness in Hmong culture is where the book gets its name, “The Spirit Catches You and You Fall Down.” 

The Hmong attitude toward American doctors was mainly negative because American doctors spend much less time with their patients than shamans (txiv neeb). “A txiv neeb might spend as much as eight hours in a sick person’s home; doctors forced their patients, no matter how weak they were, to come to the hospital, and they might spend only twenty minutes at their bedsides. Txiv neebs were polite and never needed to ask questions; doctors asked many rude and intimate questions about patients’ lives, right down to their sexual and excretory habits. Txiv neebs could offer under an immediate diagnosis; doctors often demanded samples of blood (or even urine or feces, which they liked o keep in little bottles), took X rays and waited for days for the results to come back from the laboratory—and then, after all, that sometimes they were unable to identify the cause of the problem.”

Another problem faced by the American doctors was the language barrier. However, it was not just the inability to get translators between English and Hmong but also the vast cultural gap. Many medical terms and other words have no direct translation to Hmong. The Hmong do not open up the dead bodies and therefore have no comments and no concept of organs inside the body. Surgery is taboo. “Decisions—especially about procedures, such as surgery, that violated Hmong taboos—often took hours. Wives had to ask their husbands, husbands had to ask their elder brothers, elder brothers had to task their clan leaders, and sometimes the clan leaders had to telephone even more important leaders in other states.”

Yet another issue with treating Lia Lee for her seizures and other Hmong patients was another cultural difference: measurements. They did not know how to take medication or in what amounts. Pills and proper dosages didn’t mean anything. This was a struggle for the doctors in Merced, but it was a struggle for healthcare workers in refugee camps in southeast Asia. 

For the Hmong, religion, medicine, and wellness are all interlinked rather than separated. It is all one giant system. If someone is ill, something is wrong with their soul, or an evil spirit (dab) has infected them or taken advantage of them. It wasn’t a problem of words: it was all about culture. 

The author does an excellent job of telling Lia’s story using the interposition of cultural differences. The examples I’ve used show how the author constantly compares the traditional Hmong view of the world and the Western view of the world to explain why Lia Lee was not cared for as she could have been. The cultural gap between the east and west was simply too significant. 

For my work, this book helped remind me that my enslaved characters and my white characters don’t look at the world the same way and to continually highlight the conditions between life in slavery and life as a free, white person. Racism isn’t just a trope; it is a way of life, a way of looking at the world. I want to infuse more of that into my book.