Essay: The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down by Anne Fadiman is about a Hmong family and their experience with the United States healthcare system. The Lee family are refugees from Laos, the parents Nao Kao and Foua Lee came to America and resided in Merced, California with the rest of their family. They have a daughter named Lia and she was diagnosed with epilepsy and since the Lee family doesn’t speak English it makes Lia’s treatment difficult and complicated. Dan Murphy, Peggy Philp and Neil Ernst, Lia’s doctors, try to make things work but since the Hmong and the doctors cannot communicate in the same language, Peggy and Neil end up sending Lia into a foster home where they believe Lia will get better. But as soon as Lia is away at her foster home and away from her family her health seems to get worse. When Lia returns home she constantly has major seizures and her development had not improved, but later Lia sadly experiences a severe grand seizure and it leaves her brain dead. Even though Lia is brain dead, Nao Kao and Foua try to make Lia as comfortable as they can. Lia ends up living a lot longer than the doctors expected, but Nao Kao and Foua are very hurt and upset about what happened to Lia and they blame Lia’s doctors for Lia’s illness. Nao Kao and Foua are seen as good parents, but they are stuck in a difficult situation with the healthcare system since there is such a huge language barrier between the Hmong and the Merced Community Medical Center staff. Dan, Peggy, and Neil are seen as good doctors and dedicated to helping families like the Lee family, but their cultural differences and biases towards different groups of people prevent Peggy and Neil from taking care of Lia to the best of their ability. The Lees have had a difficult time in America so far, but they’ve also suffered role loss because they are trying to adapt to a different country with their different culture roles and traditions.
Nao Kao and Foua are seen as good parents since they tried to help Lia with her epilepsy. Dan, Peggy, and Neil are seen as good doctors since they all try to help Lia with her epilepsy. Nao Kao and Foua just moved to the United States and they cannot speak English and their daughter is newly diagnosed with epilepsy and suffering from a disease they do not understand. “Foua and Nao Kao had already diagnosed their daughter’s problem as the illness where the spirit catches you and you fall down”, but they do not realize that it is a neurological disorder that is crucial to Lia’s health (Fadiman, 1997, pp. 28). The doctors accused the Lee parents of maltreating Lia since they did not give her her prescribed medications, but Lia did not like to swallow the pills and the parents were not sure about what medication and how much they were supposed to give her. Nao Kao and Foua are very dedicated and loving to their family, no matter what happens. With what happened to Lia and her seizures, Nao Kao blames western medicine and her doctors Peggy and Neil for Lia’s outcome. When the doctors sent Lia back home they expected her to die, but two years after Lia’s last seizure she was still alive and growing which the doctors were not expecting to happen. While Lia was home, her parents comforted her the best they could and gave her the right amount of medication since there was nothing else they could do. The Lee family believed in using herbal and natural home remedies instead of prescribed medications, so when the doctors prescribed Lia prescription medications Nao Kao and Foua were against it. Nao Kao and Foua were great parents to Lia, they loved her very much and were committed to caring for her even when Lia was in a vegetative state. Both the parents and the doctors are to blame for Lia’s care since the Lee parents did not understand nor speak English and Doctors Neil and Peggy did not understand the Hmong culture.
Dan Murphy, Peggy Philp, and Neil Ernst are seen as good doctors since they all try to help Lia with her epilepsy. Dan Murphy was the first doctor that assisted Lia when she came to the emergency room at MCMC, he knew a lot about the Hmong and their culture and traditions and was the first doctor to recognize and treat Lia’s epilepsy. Not many people understand the Hmong culture, but “Dan Murphy is generally acknowledged to be the one most interested in and knowledgeable about the Hmong” (Fadiman, 1997, pp. 26). Dan Murphy
“had no way of knowing that Foua and Nao Kao had already diagnosed their daughter ’s problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological disorders” (Fadiman, 1997, pp. 28).
Dan diagnosed Lia with a neurological disorder while Lia’s parents diagnosed her with a spiritual disorder, but Lia’s parents did not know that Lia’s condition was much worse and not spiritual. Dan was fascinated by the Hmong and enjoyed helping and treating Lia, but the language barrier since the Hmong did not speak English made it difficult. Lia suffered from a “grand mal episode, and Dan had no desire to do anything but stop it. He admitted her to MCMC as an inpatient” and performed numerous tests and treatments to come to a conclusion (Fadiman, 1997, pp. 30). Peggy and Neil were also very helpful doctors to Lia. They did everything in their power to take care of Lia, they devoted their time to helping families like the Lees who are at a disadvantage, even though Peggy and Neil had biases toward different cultures like the Hmong that led them to not taking the best care they could have of Lia. Lia’s doctors performed tests and procedures to figure out what to do and how to treat Lia. Peggy and Neil did their best to administer the best optimal care they could to Lia, but Peggy and Neil did not know much about the Hmong culture and never asked the Lee’s about their culture nor Lia’s epilepsy. Peggy and Neil noticed that their practice and care was not perfect nor working for Lia and they questioned themselves and what they did so they could improve Lia’s care and her outcomes. With the doctor’s help, a few years after Lia’s last seizure she was still alive even though the doctors expected her to die. During Lia’s check-up visit Neil expected Foua to blame him for Lia’s outcome, but Foua thanked Neil and hugged him. The doctors have now seen Lia as a model patient and the Lees as model parents since they took such great care of Lia for her to still be alive. Doctor Neil Ernst and Peggy Philp felt that “it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids’ lives” (Fadiman, 1997, pp. 79). Doctors Neil and Peggy were the main doctors at Merced Community Medical Center who saw and treated Lia. Neil and Peggy did not understand how the soul heals illnesses for the Hmong and that they value life and the soul. Nao Kao and Foua were good parents and Dan, Peggy, and Neil were good doctors as well because they did their best in treating Lia.
When the Hmong arrived in the United States, they suffered from role loss since they had to adapt to and practice American culture because Hmong culture is so different and new from American culture. The Lee family went through culture shock since they do not make an effort to adapt to or practice American culture. American culture is so new to the Lee family including electricity and refrigeration, but they do not make a big effort in adapting to or practicing their new environment. The Hmong came to the United States to be free and to have their own independence. The Hmong like to be self-sufficient and they enjoy being around other Hmong people. The Hmong also like to avoid conflict and they fear the American prison system. The Hmong enjoy being self-sufficient and enjoy providing and helping their family, but the Hmong lack the skills needed to provide and help their family, so that forces them to rely on government assistance to survive. The older Hmong generations believe they are lost and that they cannot adapt to the United States culture, while the younger Hmong generations believe the United States is their home since they can adapt there. The older population that held the most power and the highest status in Laos now have less power and are at a lower status then the younger population who can speak English, attend school and adapt to the United States. The younger population are understanding and taking in the American culture but slowly losing their Hmong culture. In Laos, the older Hmong population like the grandparents would have higher status then the younger Hmong population like the youngest daughters, but now since the Hmong have come to American it’s the opposite. Dr. Evelyn Lee explains that their status is the opposite in American by using this example,
“the grandfather has no job. Father can only chop vegetables. Mother didn’t work in the old country, but here she gets a job in a garment factory. Oldest daughter works there too. Son drops out of high school because he can’t learn English. Youngest daughter learns the best English in the family and ends up at U.C Berkeley” (Fadiman, 1997, pp. 206).
As the Hmong came to America, they have experienced “role loss” since the grandparents are now the most helpless and disadvantaged while the youngest daughter is the most successful and brightest of the family. Dr. Lee’s example “was an eloquent demonstration of what sociologist’s call “role loss.” Of all the stresses in the Hmong community, role loss may be the most corrosive to the ego” (Fadiman, 1997, pp. 206). The Hmong value their role and their culture and do not want to lose their role in their culture. In America “the real children have assumed some of the power that used to belong to their elders”, since the children know how to speak English and understand American culture (Fadiman, 1997, pp. 206). The Hmong seem to be suffering from “a global despair to which their economic dependence was only one of many contributing factors”. In one survey based on what ethnicity was happier and satisfied with their life, “the Hmong respondents scored lowest in “happiness” and “life satisfaction.”” In another study, it showed that the Hmong population “exhibited the highest degree of “alienation from their environment.”” And in another study where “Hmong refugees who had lived in the United States for a year and a half had “very high levels of depression, anxiety, hostility, phobia, paranoid ideation, obsessive compulsiveness and feelings of inadequacy”” (Fadiman, 1997, pp. 202-203). These studies show that the Hmong are unhappy losing their role and their culture.
Being an immigrant is difficult since you migrate and move to a new country or location and you are unfamiliar with the new setting. Immigrants and refugee groups come to a new country and they have difficulty adapting since it is such a new place and they are used to their old ways in their previous home. Immigrants and Refugee groups enjoy bringing their culture to the new place they immigrated to, so they have something from home to bring with them, something they know they can rely on since culture is important and valuable. Sometimes when immigrants or refugees come to the United States, they lost their culture and their role since they have adapted to the American culture. The Hmong want to stay Hmong and not change their culture but coming to America has changed their culture since they need to adapt to their new environment. America is the land of opportunity, but since the Hmong don’t know how to speak English or have an education in which they can work they will have a difficult time adapting to the United States. The Lee’s
“relatives told [them] about electricity and said the children shouldn’t touch those plugs in the wall because they could get hurt. They told [them] that the refrigerator is a cold had never seen a toilet before and [they] thought maybe the water in it was to drink or cook with” (Fadiman, 1997, pp. 182).
The Lee family has never seen nor learned what or how to use electricity, a refrigerator, a TV or a toilet. Coming from a country that did not have electricity, refrigerators, TVs or toilets and then residing in a country that does is hard since the immigrants do not know how to use them. The Hmong seemed to adopt skills and traits that seemed to work and be useful to them like driving cars, using telephones and toilets, but they did not learn English.
Throughout the book The Spirit Catches You and You Fall Down by Anne Fadiman there is a language barrier between the doctors at Merced Community Medical Center and Lia’s parents. The physicians at Merced Community Medical Center do not understand the Hmong culture and the Lee family does not understand the American culture. But in the end, the doctors and the Lee family both help with Lia’s disease and try to comfort her the best they can. The Hmong and the Physicians did not speak the same language so there was a lot of miscommunication and that lead to Lia’s treatment becoming very complicated, but Lia ended up living a lot longer than everyone expected and that was due to her parents and her physicians help.