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

Author: Anne Fadiman

Rating: ⭐ 3/5

Date Read: 2013/12/09

Pages: 341

I feel incredibly conflicted about this book. It’s two books, really, one of which is quite good, one of which isn’t. The good book is the one that details the story of the Hmong people. Before reading this, I was unaware of their role in the Vietnam War, as well as the fact that there are a sizable number of Hmong refugees in my home state of California. It was particularly interesting to learn about their customs. More than once in the book, Fadiman talks about sacrificing a pig as if that’s some sort of bat-shit crazy thing to do, but I think we’d be much better off if everyone treated the source of their food with that much personal reverence.

Two books: one about the Hmong, which was generally excellent, and another about a little Hmong girl with epilepsy, which made me want to throw the book against the wall. Repeatedly.

So the thing that really bothers me about this book is that Fadiman seems to take it for granted that doctors know best. Fadiman talks about how brilliant Lia’s pediatricians were (if I were to be objective here, based on the interviews with said pediatricians, I say they come off as middling and arrogant, but whatever). She writes about a doctor who respects his patients’ right to have a say in their treatment as if he’s an idiot, saying “Roger Fife happened to espouse a philosophy that carried more weight with the Hmong than any degree of knowledge, intelligence, or technical skill.” Her bias is obvious, but she still claims that her books is objective.

Alright, so here’s the thing: it would be one thing if doctors really were these magical, ethereal beings who knew exactly the right path to take to treat all illnesses. But, as a scientist myself, I can safely say that even the most intelligent people don’t know shit about anything, especially not about the brain. Example: one particularly famous patient, H.M., had intractable epilepsy that was treated by the surgical removal of most of his hippocampus. And it totally worked: no more epilepsy! Unfortunately, the hippocampus is kind of important: to simplify, it is in charge of consolidating short-term memory into long-term memory. So H.M. ended up having anterograde amnesia, which meant that he was unable to form any new long-term memories. This was a boon for science (we researched the hell out of that guy), but not so much for H.M.

Now, I’m not saying that doctors are idiots or anything, nor am I saying that Western Medicine isn’t a good thing. But it’s one thing to consult with a doctor, and another to blindly follow his or her advice, especially given the state of health care in the U.S. and the influence of pharmaceutical companies (did you see the new recommendations for statins yet? Um, yeah). Yet, this is exactly what Fadiman seems to think that the Lee family should have done: there’s evidence of this on page after page. About 70 pages in, that really began to grate on me.

The issue for Lia Lee wasn’t that her parents wanted to treat her one way, and the doctors wanted to treat her another way. No no. The issue was that her parents were refugees who were not literate, did not speak English, were not offered translators, and could not truly consent to anything. Yet the doctors were completely unwilling to take the time to make sure her parents understood her course of treatment, or take her culture into account at all. At one point, one of the doctors treating Lia mistakes her for a boy, and Fadiman uses this as evidence of how well she had been treated(?!?!?!?). So this book, the second book, really is less about cultural clash, and more about the failings of a medical system that has never worked well, and that works particularly poorly for those who don’t have the ability to advocate for themselves.