Initially recommended to me by a medical school student ...



Shuvro De

BIOE 301

Book Report EC

The Spirit Catches You and You Fall Down

Anne Fadiman’s The Spirit Catches You and You Fall Down accounts the tragic clash of cultures that surrounds the medical treatment of Lia Lee, a young Hmong girl diagnosed with severe epilepsy. As doctors attempt to treat Lia, they are confronted with the recalcitrant attitude of Lia’s parents, whose native culture perceives epilepsy as a divine gift: the touch of God upon one’s soul. Fadiman describes the origins of this divine belief and many of the traditions associated with Lee’s back to the legendary Hmong tribe of Laos, whose familial bonds are not easily broken. In the end, Lia suffers the greatest from the great clash as she suffers irreversible brain damage that renders her unable to function in a complete “vegetative state.” While the doctor’s work could not relieve Lia of her epilepsy, the nature of this heartwrenching and tragic story teaches not only lessons in medicine, but of humanity in its most primitive form.

Though the story of Lia herself is of primary significance, a dimension of her tragedy should be taken in the context of the dramatic cultural barrier that never seemed to dissolve. The story of Lia and her family remind us that culture is not an entity so easily shaped, especially by those born outside of its borders. While the doctors made genuine efforts to treat Lia, they failed because they were unable to integrate Western and Hmong medicine. And while Lia’s parents had high hopes for their daughter’s treatment, they were unwilling to sacrifice their cultural beliefs in exchange for American medicine. As a once glorious tribe in Laos with intimate communal bonds, the transplantation of the Hmong into the Western society only further reinforced their closeness as they were skeptical of outsiders, especially ones that attempted to impose coercion. At odds with this skepticism was the Western practice of medicine, which does not tolerate objections to the prescribed treatment and where the doctor’s word is always the last. This juxtaposition of these perspectives in the context of this innocent girl brings to light the devastating consequences when two antagonistic worlds fail to reconcile their differences.

Fadiman’s account of the Lee’s unfolded as a whirlwind of emotions. On the one hand, I sympathized greatly with Lia’s parents who witnessed the deteriorating condition of their daughter at the hands of people who claimed to be helping their daughter. However, I also sympathized with and very much admired the doctors who sacrificed their personal lives both to comfort Lia during her numerous seizures in the middle of the night and to learn about the Hmong culture in hopes that they would be able to overcome the daunting cultural barrier that existed between them and Lia’s parents. Despite her parent’s obstinate objections to American medical therapy, Lia’s doctors demonstrated their compassion towards her not as one of their cases, but as if she were their own daughter. However, with great reluctance and sadness, they told the Lee’s they could do nothing more for Lia.

Fadiman’s account can be construed as a mere microcosm for the numerous other cultural clashes involving the practice of medicine in developed and undeveloped countries. Having a relative involved in the CDC/WHO Global Polio Eradication Initiative in South Asia, I have been able to witness the frustration involved at attempts to administer to the polio vaccine to unreceptive populations. Poliomyelitis, a disease so close to being eradicated, continues to plague less developed countries such as India and Nigeria as people believe that the vaccine is a Western ploy to sterilize them. Like much of what have studied in this class, differences in prevalence of certain diseases is not so much to the geographical distribution of pathogens, but to the financial ability to pay for and also to cultural compatibility to accept certain treatments. Disease prevalence cannot be explained simply by the “haves and have-nots,” but rather a discrepancy of two “haves”—cultures that have diametrically opposed perspectives that each consider themselves to be superior to the other. As an author, Fadiman achieves success in using her book as both a source of medical knowledge and a tragic account of cultural confrontation. With an uplifting and resolute tone, Fadiman ends the story with a hopeful notion that someday this cultural dichotomy of East and West can be reconciled.

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