Evelyn Ostler

Mr. Jensen

Ethnic Studies

15 March 2024

The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down, written by Anne Fadiman, is a book about

Lia Lee, a Hmong child born with a severe case of epilepsy. Fadiman highlights the difficulties

that the Lee family endured in America during their time with Lia, due to multiple barriers such

as language and culture. She does so in a way that does not present any bias to either side, and

allows the reader to gain a sympathetic understanding of where both are coming from. The

multiple conflicting scenarios throughout the book make the reader question where they really

stand, and promote deeper thinking on the subject of law versus culture within healthcare.

Fadiman was brilliant in the way she presented information, providing a good balance between

telling a story and providing historical context to back it up. This thought provoking book will

have readers second guessing themselves, and have more sympathy towards those who come

from different backgrounds.

Anne Fadiman is an author, writer, and reporter from Connecticut. She graduated from

Harvard University in 1975 with a bachelor of arts degree. Throughout her career, she mainly

specialized in editing, reporting, and teaching students with an interest in publishing. Before

publishing/while writing her 8 time award winning book, The Spirit Catches You and You Fall

Down, Fadiman spent 9 years in Merced California interviewing those involved in the story,

researching Hmong culture and history, and personally connecting with the Lee family in order

to accurately present the story in its entirety. She felt it irresponsible to spend any second less
than she did gathering all of the information due to the weight that this story could potentially

have on society; this hypothesis became a reality as her book was and is still used across the

country to teach those with interest in medical/cultural ethics about the significance of respecting

both aspects.

Overall, I found this book to be very eye-opening. It brought up topics and questions that

I had never thought of before, and it made me question my stance in a lot of areas. I often found

my opinion contradicting itself when the two different perspectives were presented, and it made

me think harder about other cultures. One of the main topics, and the biggest question that I had

throughout reading, was: Who is right? Is anyone right? Is anyone wrong? Each time I thought I

had the answer, I would put myself in the other side’s shoes and be back at square one. For

example, a big issue between the Hmong and the American medical system was the perception

of American doctors that the Hmong had. In comparison to the Hmong’s traditional beliefs–

natural remedy, soul ties, animal and human connection, spirits good and bad–western medicine

seemed evil and wrong. Some big concerns for them included doctors inspecting genitals, cutting

people open, giving medicine that makes patients “sicker”, etc. Coming from someone that was

born and raised learning about and experiencing western medicine, it seems strange that the

Hmong think this because it is what is normal for us. However, western practice is also

understandably strange from the Hmong point of view, because it isn’t normal for them. I

thought that the comparison between the two was presented very well throughout the book, as I

found myself getting frustrated with both the Lee’s noncompliance and the doctor’s insensitivity.

I admired the fact that Fadiman made sure to highlight the growth within the Lee family

and within the medical staff that treated Lia. In the beginning, the Lees wanted nothing to do

with doctors or hospitals or treatments, they simply wanted to fix their daughter. This and the
multiple communication barriers made it difficult for the doctors to work with them and try to

provide the best possible care for their patient. Many doctors ended giving up easily, but those

that persevered managed to help the Lees understand western medicine a little better than before.

I especially liked the doctors that allowed the Lees to implement their cultural beliefs as much as

they safely could within a hospital. Having these trustworthy doctors allowed the Lees to feel

safe trying new things on Lia, resulting in a slight improvement in her health, even though they

were a little too late.

I found myself to be a little confused in alternating chapters when the story would

backtrack and go into the history of Hmong culture. I appreciate the reasoning behind

implementing this background, as it gives the reader more context as to where the Lees came

from and why they believe what they believe. It was really interesting to learn about the different

practices and many big events that occurred in their villages, however I struggled to relate it to

the current situation in Lia’s timeline. Without these chapters, the book would definitely have a

different tone and maybe even send a different message to some readers. I feel like I would be

able to interpret them better if I read the book a second time knowing what I know now about the

story, as I feel a lot of these chapters were foreshadowing what was to come.

I would highly recommend this book to anyone who is interested in the medical field,

medical ethics, cultural differences, and immigrants/refugees. This book does an excellent job at

covering each of those areas, and creates an abstract level of thinking within oneself. I feel like

this book isn’t like any other book among these topics, as it applies them to reality using the

story of a real family to provide perspective. It’s easy to get lost in typical non-fiction and

research, and reading this book would definitely break that cycle through creative storytelling.

Even though these topics aren’t my highest priority interest wise, I found myself coming up with
my own scenarios in my head to imagine what it would be like if I was faced with a similar

challenge/question of this scale.

Quotes

“Our view of reality is only a view, not reality itself.” page 276. I thought this quote was

very profound and thought provoking. I thought this perfectly gave reason as to why the Lees

and the doctors thought so differently, even though they were in the same place at the same time

seeing the same things. This quote stuck with me for the entirety of the book to strengthen my

opinions, and I feel that its philosophy is going to stick with me forever.

“You can miss a lot by sticking to the point.” page 13. I liked the fact that this

emphasized a think-outside-of-the-box mindset. It not only applied to what was going on in the

story, but the reader can also apply it to themselves while they read.

“If the soul cannot find its jacket, it is condemned to an eternity of wandering–naked and

alone.” page 5. I found this quote to be really metaphorical. In context, it was simply describing

a Hmong belief regarding the soul. However, after coming back to this quote after finishing the

book, I related the jacket to one’s culture and understanding of the world; without it, what else is

there?

“I have always felt that the action most worth watching is not at the center of things but

where edges meet. I like shorelines, weather fronts, international borders. There are interesting

frictions and incongruities in these places, and often, if you stand at the point of tangency, you

can see both sides better than if you were in the middle of either one.” page viii. I thought this

related to the overall theme of this book really well. It gave context as to how Fadiman chose to

write this story, as she puts the reader at the shorelines between each side rather than in the ocean

of each.
 “It is well known that involuntary migrants, no matter what pot they are thrown into, tend

not to melt.” page 183. This quote gave a lot of understanding as to why the Lees thought and

behaved the way they did throughout Lia’s treatment. After learning more about “the melting

pot” in the United States, it all makes sense especially when you think about the fact that the

Lees came seeking refuge, not change.

“This is heaven for them! They have a toilet they can poop in. They can drink water from

an open faucet. They get regular checks and they never have to work.” page 235. This quote

came from a doctor from MCMC speaking about his anger toward Hmong refugees. I found this

incredibly ignorant, however the book mentioned that his opinions on them were much like the

public’s opinions. I wanted to include this quote because I think it shows how quick people can

assume things about others, especially those coming from different backgrounds. His statement

couldn’t be further from the truth, as many Hmong didn’t like their new lifestyles.

“‘Parents counseled of Risks/Benefits/Alternatives thru interpreter…Appear to

understand and wish to proceed.’ In fact, her parents had no idea what any of these procedures,

which were scheduled for the following two days, entailed.” page 150. I thought this quote

perfectly summed up the experience that the Lees had throughout Lia’s medical journey. They

always had some sort of interpreter for them, but they weren’t always the most accurate or

trained. Because of this, the majority of the information wasn’t clear and all the Lees could do

was blindly agree.

“‘The best thing I could have given Lia’s mother was compassion, and I wasn’t giving

her any and I knew I wasn’t giving her any…There was too much aggravation. It was like

banging your head against a wall constantly and not making any headway…’” page 56. I thought

this quote gave Dr. Neil’s point of view a voice pretty well. This was said after he had found out
that Lia’s mother Foua was not giving her any of the medication that he had prescribed. He

explained his awareness of the situation, but he also defended himself and didn’t invalidate his

feelings. As a medical professional, Neil of course had to remain professional, so I thought that it

was important to show the real and human side of him.

Overall, I would give this book 4 out of 5 stars. I liked the fact that it was different from

many other biographies, and it gave me a lot of perspective about the world. I now view people

differently and in a more positive way, especially those coming from different cultures and

backgrounds. It helped me to remember that our view of reality is only a view, not reality itself,

and that my view is just as important and valid as other people’s views. Empathy and sympathy

are things that I pride myself in having, and while I can’t directly empathize with the Lee family

for obvious reasons, I definitely gained a lot of sympathy for them and those in similar situations.

It also gave me a better understanding of the medical field in general, and what truly happens in

the minds of care providers. I gained a similar sympathy for them as well. This book

significantly changed how I see the world, and expanded so many different aspects of my mind

by questioning myself and where I stand.