The Spirit Catches You and You Fall Down by Anne Fadiman.
Farrar, Straus, and Giroux, New York, my edition 1998 (first published 1997).
Nonfiction, 341 pages +reader’s guide.
This is the story of a severely epileptic Hmong girl and the family and doctors who wanted what was best for her but disagreed about what that was. It’s also the story of the Hmong people in America, and their experiences with the medical establishment.
This is technically a re-read. However, I didn’t remember much, so it was like reading a new book. The primary story in this book is Lia’s life and the friction between her family and the medical staff caring for her, but it has a wide scope.
Entire chapters sprinkled throughout the book tell the story of the Hmong people, specifically the groups that migrated to Laos and eventually to America (as Lia’s parents did). While I recall initially finding these chapters fascinating, this time around they didn’t hold my interest as well and felt comparatively dull.
For a shorter reading experience, you can skip the stories on Hmong culture and history, although the background knowledge does give a richer understanding of Lia’s family. The Hmong religion permeates all aspects of their life, so an understanding of their medical decisions must include their thoughts about Lia’s soul.
I reread this book after Prisoners Without Trial, and the juxtaposition was fascinating. The Japanese Americans were the first “model minority” and experienced a wide turn around in public opinion. While the Hmong seem like a model minority in many respects, they’re disliked by white Americans. All the original Hmong migrants wanted was what the earlier Japanese immigrants had – to live in isolated, segregated communities and farm. Instead, they were sent to inner cites.
Spoilers / I’d forgotten that foster care was part of this. One of Lia’s doctors is so upset at the family’s non-compliance that he reports them to social services and Lia is removed. Since they are admittedly not following the drug regime recommended by the doctors, Lia is placed with a foster family. However, it also becomes obvious that Lia’s medicines aren’t preventing her seizures! She’s eventually returned, thanks to her foster mother and social worker. / End of Spoilers
The genius of this book is that, while it starts off showing us more of the doctor’s perspective, in the long run it does not favor either view. Lia’s parents were right about things the doctors missed, and the doctors were right about things that Lia’s parents didn’t understand. Fadiman stands in the middle, sympathizing with both sides but ultimately feeling that a lack of communication and understanding is at fault for this tragedy.
Fadiman was present at points in this story, but I never felt she was unnecessarily inserting herself into the narrative. Unlike The Immortal Cells of Henrietta Lacks, Fadiman sought to examine her own biases. She’s humble and respectful, repeatedly admitting in her text (now used in college courses) that she’s a rank beginner in Hmong culture and owes any understanding to those who helped her.
Some aspects are dated. I’d forgotten that “veterinary medicine” was common before interpreters were widely available. New medical privacy laws make it difficult for staff to use some of the workarounds involving family or clan members. But the core ethical questions have not changed.
This book describes childbirth, animal sacrifice, and extreme medical circumstances. The experiences of Hmong fleeing Laos could disturb sensitive readers. Intended for adults, could be read by teens. I’d recommend reading with an adult who could handle difficult topics and help students process the events.
I’ve only ever discussed this book with the friend who initially lent me the book a decade ago, but it’s ideal for discussion and contemplation. Many questions are raised, but few answers are given. What you take from this book will depend on what you bring to it. Recommended.